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Antibiotic Prophylaxis for Congenital Cardiac Catheterizations: Lessons Learned From the Pediatric Health Information
Bayan Issa1, Kamel Shibbani2, Isabella Zaniletti3
1Department of Pediatrics, University of California-San Diego, La Jolla, California, USA; Division of Cardiology, Rady Children's Hospital, San Diego, California, USA.
Insights
Antibiotic prophylaxis (ABP) use varies for congenital heart procedures. This study found no link between ABP dosing and early infective endocarditis (IE), which is rare and procedure-dependent.
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.
Background:
There is significant antibiotic prophylaxis (ABP) variability before congenital cardiac catheterization procedures. The true incidence of procedure-related infective endocarditis (IE) remains unclear.
Objective:
This study aimed to evaluate national periprocedural ABP utilization patterns and determine whether ABP dosing strategies are associated with early postprocedural IE.
Methods:
A retrospective cohort study was conducted using data from the Pediatric Health Information System from 39 pediatric centers. Data were collected on the following 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. Outcomes assessed were: 1) rate and pattern of periprocedural antibiotic use and 2) incidence of early IE within 30-days postprocedure.
Results:
A total of 20,580 procedures were analyzed. Antibiotic dosing varied significantly by procedure, with the proportion of patients receiving ≥2 doses ranging from 38.8% for PDA closure to 85.7% for TPVR. A total of 15 IE cases (0.07%) were identified within 30 days, more than half of which followed TPVR (53%). The incidence of early IE varied significantly by procedure type (P = 0.003): TPVR (0.27%), pulmonary valvuloplasty (0.12%), atrial septal defect closure (0.04%), and PDA closure (0.02%). There was no measurable association between ABP and early IE.
Conclusions:
Procedure-related IE is exceedingly rare and is significantly related to procedure type. We did not observe a measurable association between early IE and ABP dosing. These findings underscore the need for standardized, evidence-based guidelines to optimize antibiotic protocols for congenital cardiac catheterization.
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