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

Abstract

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.

Figure 1. Number of IE cases over time

The grey boxes represent the number of total patients hospitalized with IE during the time period specified. The solid lines represent 95% Poisson confidence intervals. The dotted line represents when the new AHA guidelines were published.

Figure 2. Number of IE cases over time indexed to total hospital admissions

The black squares represent the number of patients hospitalized with IE per 1000 total hospital admissions during the time period specified. The solid lines represent 95% Poisson confidence intervals. The dotted line represents when the new AHA guidelines were published.