Abstract 10752: Trends in Hospitalization for Infective Endocarditis at US Children's Hospitals: Impact of the 2007 American Heart Association Antibiotic Prophylaxis Guidelines
Background: In April 2007 the American Heart Association published guidelines recommending cessation of antibiotic prophylaxis for infective endocarditis (IE) prior to dental procedures for all but the highest risk patients. The impact of these guidelines is unclear. We examined trends in IE hospitalizations at US Children's Hospitals during this time period.
Methods: The Pediatric Health Information Systems (PHIS) Database was used to evaluate children <18 yrs hospitalized with IE at 37 centers submitting data from 2003-2010. Only the index hospitalization was analyzed. Using Poisson regression, we evaluated the number IE hospitalizations over time (raw and indexed to total hospital admissions).
Results: A total of 1157 IE cases were identified: median age 2.9 years (interquartile range 2.5mo - 12.4yr), 31% had a diagnosis of congenital heart disease (CHD). In-hospital mortality was 1.1%. We did not detect a significant change in the number of IE cases over time: 1.6% difference in annual number of cases post vs. pre guidelines (95% CI -6.4 to 10.3%, p=0.7; Figure). Indexed to the total number of hospital admissions, there was a significant decline in the number of IE cases/1000 admissions over time prior to the guidelines (-5.9% change in annual rate, 95% CI -9.9 to -1.8, p=0.005) which was not significantly altered in the post-guidelines period (Figure). Results were similar in the subset with CHD, and those 5-18yrs (subgroup most likely receiving dental care). There was no significant change over time in IE cases coded as oral streptococci.
Conclusions: We found no evidence of an upward trend in IE admissions across 37 US Children's Hospitals following new antibiotic prophylaxis guidelines. Evaluation of changes in prescribing patterns and more detailed assessment of high risk patients is warranted to further characterize outcomes related to the new guidelines.
- © 2011 by American Heart Association, Inc.