Bacterial endocarditis prophylaxis: What is recommended and what is practiced?

Abstract

Study Objective: To determine how often pediatric anesthesiologists follow the American Heart Association (AHA) recommendations for the administration of prophylactic antibiotics to prevent bacterial endocarditis (BE). Design: Questionnaires mailed to all members of the Society for Pediatric Anesthesia regarding their use of antibiotics to prevent BE. Setting: Anesthesia department at a university-affiliated children's hospital. Measurements and Main Results: 898 questionnaires were mailed, and 465 questionnaires were returned, yielding a response rate of 52%. When anesthesiologists administer BE prophylaxis intravenously (IV), they perform an inhalation anesthetic 76% of the time prior to establishing IV access. Ninety percent of the respondents stated that if administration of antibiotics occurs after a mask induction, they do not delay incision or instrumentation for 30 minutes. Therefore, respondents do not follow AHA recommendations for BE prophylaxis 55% of the time. Of the 465 respondents, only 4 recalled pediatric patients who developed perioperative BE. Conclusions: The majority of anesthesiologists responding to this survey routinely do not follow the current AHA recommendations for BE prophylaxis when caring for children. Since there are no studies demonstrating that administering antibiotics 30 minutes prior to invasive procedures is more effective than administering antibiotics immediately prior to invasive procedures, it may be appropriate to follow a time sequence that is more comfortable and convenient for pediatric patients. We believe that a reconsideration of the current AHA recommendations for BE prophylaxis is warranted.