7205 Intercollegiate-british society of gastroenterology national colonoscopy (ibsn) audit: do colonoscopists follow the british society of gastroenterology guidelines regarding antibiotic prophylaxis?

Abstract

Introduction: British Society of Gastroenterology (BSG) guidelines recommend antibiotic prophylaxis for endoscopic procedures if the patient is at high risk of endocarditis or of symptomatic bacteraemia because of immunosuppression or neutropenia. As part of the IBNC audit the practice of antibiotic prophylaxis was assessed in colonoscopists practising in 73 units (44 District General, 10 Teaching, 5 Paediatric, 14 Private). Results: Antibiotic prophylaxis for 19 clinical conditions were addressed by 228/236 colonoscopists. The number of colonoscopists who indicated they would give antibiotic prophylaxis to patients undergoing colonoscopy with conditions associated with a higher risk of endocarditis or symptomatic bacteraemia are: Prosthetic heart valve - 226/228 (99.1%), Previous endocarditis - 206/228 (90.4%), Surgically constructed systemic-pulmonary shunt or conduit - 97/228 (42.5%), Synthetic vascular graft less than 1 year old - 116/228 (50.9%), Severe neutropenia (neutrophils 9 /litre) - 179/228 (78.5%). 96/228 (42%) of colonoscopists were members of the British Society of Gastroenterology but there was no significant difference between members and non-members responses in these higher risk clinical conditions. The BSG guidelines designate 14 other clinical conditions as having moderate, low or no increased risk of endocarditis or symptomatic bacteraemia and where antibiotics are not recommended. The number of colonoscopists who indicated they would give antibiotics to patients undergoing colonoscopy with these conditions ranged from 173/228 (75.9%) for rheumatic valvular or congenital cardiac lesions, to 20/228 (8.8%) for an orthopaedic prosthesis. Conclusion: Not all patients with disorders associated with a higher risk of endocarditis or symptomatic bacteraemia receive prophylactic antibiotics prior to colonoscopy and prophylaxis is often administered inappropriately. More effective methods are required to improve awareness and implementation of prophylactic antibiotic guidelines.