Clinical Investigation
Pediatrics
Trends in endocarditis hospitalizations at US children's hospitals: Impact of the 2007 American Heart Association Antibiotic Prophylaxis Guidelines

https://doi.org/10.1016/j.ahj.2012.03.002Get rights and content

Background

In 2007, the American Heart Association recommended cessation of antibiotic prophylaxis for infective endocarditis (IE) before dental procedures for all but those at highest risk for adverse outcomes from IE. The impact of these guidelines is unclear. We evaluated IE hospitalizations at US children's hospitals during this period.

Methods

Children <18 years old hospitalized from 2003 to 2010 with IE at 37 centers in the Pediatric Health Information Systems Database were included. 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; 68% had congenital heart disease (CHD). The raw number of IE cases did not change significantly over time (+1.6% difference post vs pre guidelines, 95% CI −6.4% to +10.3%, P = .7). When the number of IE cases was indexed per 1,000 hospital admissions, there was a significant decline during the time period before the guidelines (annual change: −5.9%, 95% CI −9.9 to −1.8, P = .005) and a similar decline in the post guidelines period such that the difference between the 2 periods was not significant (P = .15). In subgroup analysis, no significant change over time in IE cases (raw or indexed) was found in the CHD subset, those 5 to 18 years old (subgroup most likely receiving dental care), or in cases coded as oral streptococci.

Conclusions

We found no evidence that release of new antibiotic prophylaxis guidelines was associated with a significant change in IE admissions across 37 US children's hospitals.

Section snippets

Data source

Data for this multicenter, retrospective study were obtained from the Pediatric Health Information System (PHIS) Database, a large administrative database containing inpatient data from 41 children's hospitals in the United States affiliated with the Child Health Corporation of America (Shawnee Mission, KS). The database currently contains information from >5 million inpatient discharges and has been used extensively in pediatric outcomes research.4, 5, 6 Pediatric Health Information

Study population

A total of 1157 cases of hospitalization for IE during the study period were identified. Study population characteristics are displayed in Table I. Median age was 2.9 years (interquartile range 2.5 months to 12.4 years), and 68% of the cohort was coded as having CHD. In-hospital mortality for the overall cohort was 1.1%.

Hospitalization for IE over time

In analysis of the overall cohort, we did not detect a significant change in the raw number of IE cases over time, before and after the new guidelines were published in 2007:

Discussion

In this multicenter, observational analysis, we did not detect a significant difference in hospitalizations for IE across 37 US children's hospitals before and after revision of the AHA antibiotic prophylaxis guidelines in 2007. Endocarditis, although uncommon, can be associated with significant morbidity and mortality including hospitalization for treatment of the infection, heart failure, embolization, stroke, cardiac valve replacement surgery, and death.1, 7 Mortality associated with IE

Conclusions

In this multicenter analysis, we did not find a significant change in the number of hospitalizations at US children's hospitals for IE before and after revision of the AHA antibiotic prophylaxis guidelines. Evaluation of prescribing patterns and more detailed assessment of high-risk patients are warranted to further characterize outcomes related to the new guidelines.

References (21)

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Funding sources/disclosures: Dr Pasquali: grant support (1K08HL103631-01); National Heart, Lung, and Blood Institute; and the American Heart Association Mid-Atlantic Affiliate Clinical Research Program. Dr Shah: grant support National Institute of Allergy and Infectious Diseases (K01 AI73729) and Robert Wood Johnson Foundation Physician Faculty Scholar program.

J. Michael DiMaio, MD, served as guest editor for this article.

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