Antibiotic Prophylaxis for Congenital Cardiac Catheterizations: Lessons Learned From the Pediatric Health Information...

Area of Science:

• Cardiology
• Infectious Diseases
• Pediatrics

Background:

• Significant variability exists in antibiotic prophylaxis (ABP) use prior to congenital cardiac catheterization.
• The actual incidence of procedure-related infective endocarditis (IE) following these procedures is not well-established.

Purpose of the Study:

• To analyze national patterns of periprocedural ABP utilization.
• To determine if ABP dosing strategies correlate with the occurrence of early postprocedural IE.

Main Methods:

• Retrospective cohort study utilizing data from the Pediatric Health Information System across 39 pediatric centers.
• Included procedures: patent ductus arteriosus (PDA) device occlusion, atrial septal defect device occlusion, ventricular septal defect device occlusion, transcatheter pulmonary valve replacement (TPVR), and pulmonary or aortic balloon valvuloplasty.
• Assessed outcomes included ABP use rates/patterns and incidence of early IE within 30 days postprocedure.

Main Results:

• Analysis of 20,580 procedures revealed substantial variation in antibiotic dosing by procedure type.
• Fifteen cases (0.07%) of IE were identified within 30 days, with 53% occurring after TPVR.
• IE incidence varied significantly by procedure: TPVR (0.27%), pulmonary valvuloplasty (0.12%), atrial septal defect closure (0.04%), and PDA closure (0.02%).
• No significant association was found between ABP and early IE.

Conclusions:

• Procedure-related IE is rare and strongly associated with the specific procedure type.
• No measurable association was observed between early IE and ABP dosing strategies.
• Findings highlight the need for standardized, evidence-based guidelines for antibiotic protocols in congenital cardiac catheterization.