Endocarditis Prophylaxis in ACHD

Abstract

In the United States, there has been a change in the epidemiology of infective endocarditis (IE) due to [1]: Decreased prevalence of rheumatic heart disease An increase in invasive procedures and prosthetic device implantations Increase in high-risk patient groups (intravenous drug users, patients with human immunodeficiency virus infections, and diabetes mellitus) Increase in survival of IE-risk prone populations, such as adults with congenital heart disease (CHD) There has been a steady increase in the incidence of IE over the past decade (15 per 100,000 population) [2]. Patients with underlying CHD are at a higher risk of developing IE with an increased mortality [3]. Among the unoperated patients, those who have small ventricular septal defects are at highest risk of IE but are associated with low risk of mortality [4, 5]. Common pathogens in adult patients with CHD are Staphylococcus and Streptococcus. Revised guidelines for antibiotic prophylaxis for prevention of IE were released in 2007 by the American Heart Association (AHA) and the American College of Cardiology (ACC), and a focused update was released in 2008 [6, 7]. European Society of Cardiology guidelines for endocarditis management were followed in 2009 and recently updated in 2015. Both the societies restricted the use of antibiotic prophylaxis to highest-risk patients [8]. In 2008, the National Institute for Health and Care Excellence (NICE) guidelines in the UK published recommendations against any antibiotic prophylaxis for dental or non-dental procedures regardless of the patient’s risk [9]. In a follow-up analysis of UK data collected from 2000 to 2013, there was a significant decrease in antibiotic prophylaxis prescriptions, whereas there was an increase in the incidence of IE in both high-risk and lower-risk patients starting in 2008 [10].