Abstract 17235: Trends in Endocarditis Hospitalizations at US Children's Hospitals From 2003-2014: Impact of the 2007 American Heart Association Antibiotic Prophylaxis Guidelines

Abstract

Introduction: Over the past decade, national organizations in several countries have released more restrictive guidelines for infective endocarditis (IE) prophylaxis, including the American Heart Association (AHA) 2007 guidelines. Multiple initial studies demonstrated no change in IE rates over time following release of these guidelines, however a more recent analysis over a longer time period in the UK suggested an increase in IE. This prior study primarily included adults. Current IE trends in the pediatric population are unknown. Methods: Children (<18 years) hospitalized with IE at 29 US centers participating in the Pediatric Health Information Systems Database from 2003-2014 were eligible for inclusion. Our primary analysis focused on IE most directly related to the change in the AHA guidelines, and included community-acquired IE cases (antibiotics covering oral streptococcal species started within 7 days of admission) in those >5 years of age (most likely to be receiving dental care). Interrupted time series analysis was used to evaluate IE rates over time indexed to total hospital admissions. Results: A total of 841 IE cases were identified. Median age was 13 years (interquartile range 9-15 years). In the pre-guideline period, the IE rate increased slightly over time (+0.013 IE cases/1000 hospitalizations per 6-month period, see Figure). In the post-guideline period there was a similar trend in IE rates (+0.012 IE cases/1000 hospitalizations per 6-month period) with no significant difference in slope in the pre vs. post period (p=0.9). Additional analyses in those with congenital heart disease, and in those hospitalized with any type of IE (not limited to oral streptococci) at any age, revealed similar results. Conclusions: In contrast to a recent UK study, we found no evidence of a change in IE hospitalization rates associated with revised IE prophylaxis guidelines over an 11 year period across 29 US children’s hospitals.