Antibiotic prophylaxis in patients with infectious risk factors undergoing gastrointestinal endoscopic procedures

Abstract

Consecutive patients undergoing gastrointestinal endoscopic procedures were prospectively evaluated for the presence of risk factors for the development of infectious complications that indicated a need for prophylactic antibiotics. Criteria for the evaluation of risk factors were based on (a) former American Heart Association guidelines, (b) current American Heart Association guidelines, and (c) American Society for Gastrointestinal Endoscopy guidelines. Four hundred eighty-six patients underwent 507 procedures. Risk factors for the development of endocarditis or other infectious complications were found in 74 (15%) of all patients during the study period. Cardiac conditions in 51 patients were the most frequently encountered risk factor (69% of risk factors, 10% of all patients), with mitral valve prolapse in 25 patients accounting for 49% of patients with cardiac risk factors and 5% of all patients. Of the patients with mitral valve prolapse, 7 (28%, 1.4% of all study patients) had associated valvular regurgitation. None of the patients with mitral valve prolapse knew whether or not they had associated valvular regurgitation, and if they had had a previous echocardiogram, they were unaware of the results. Only 0.8% of patients had a prosthetic heart valve. The most common non-cardiac risk factor was the presence of a prosthetic joint (9 of 486, 1.8%). Of the 486 patients, 14 required antibiotic prophylaxis according to the above-mentioned guidelines. Six of the 14 patients were given either a non-recommended antibiotic or the wrong dose of a recommended antibiotic.

Conclusions: (1) A decision regarding whether to administer antibiotic prophylaxis had to be made in 15% of patients undergoing endoscopy.(ABSTRACT TRUNCATED AT 250 WORDS)