Abstract 12225: The Impact of Cessation of Antibiotic Prophylaxis for the Prevention of Infective Endocarditis in Children: A Population-Based Study in England
Background: In March of 2008, the National Institute of Health and Clinical Excellence (NICE) in the United Kingdom instituted guidance recommending complete cessation of antibiotic prophylaxis (AP) for all patients undergoing dental procedures. We sought to evaluate the impact of this recommendation on the incidence of infective endocarditis (IE) in children.
Methods: We accessed the National Health Service Secondary User Service data warehouse to obtain national inpatient hospital data for patients <18 years of age discharged in England with IE between April 2000-March 2010 and national AP prescribing data. Trends over the time period were investigated using a Poisson regression model correcting for population changes. We also evaluated the number of cases, hospital mortality, length of stay (LOS), and the microbiologic etiology of IE over this time period.
Results: Over the 10 years, there were 373 cases of IE (60% male) with a median age of 9 years. The mean LOS was 23± 33 days and 96% were discharged alive. Data on the causal organism were available in 60% of cases; of these, 35% were streptococcal, 15% were oral streptococcal, and 25% were staphylococcal in origin. There was an overall increase (5.6% annual change, 95% CI 0.3-11.2%, p=0.038) in the incidence of IE before NICE guidance that was not significantly altered afterwards [Figure] with no change in microbiologic etiology. Overall, national prescriptions for AP fell 79% after the NICE guidance.
Conclusion: There was no observable change in the upwards incidence of IE in children in the 2 years following NICE guidance to cease AP for dental procedures. On-going monitoring and further studies are needed to confirm this observation, evaluate factors contributing to the increase in IE, and determine whether AP has a role in children at high risk for IE.
- © 2011 by American Heart Association, Inc.