Background NICE guidelines on antibiotic prophylaxis against infective endocarditis (IE) were published in 2008 resulting in a change in practice. There are recommendations for ongoing audit to monitor the incidence of IE, particularly in the high risk congenital heart disease (CHD) population.
Methods This is a retrospective review of cases of infective endocarditis in paediatric patients with CHD in Scotland. Patients were identified from the cardiac unit database. The current 30-month period was compared to two previous audits that covered the period immediately before and after the guideline release.
Results The period prior to the guidelines only identified 2 cases but this is most likely due to under-reporting. The period following the guidelines identified 8 cases of IE compared with 15 cases in the current study period. All patients had a history of cardiac surgery, median age was 5 years, median weight 19 kg and 4/15(26.7%) had DiGeorge syndrome. Only 1/15(6.7%) had a dental procedure and another 4/15(26.7%) had a cardiac surgical procedure within 3-months of diagnosis. Therefore the majority (10/15(66.7%)) had no invasive procedure within 3-months of diagnosis. Of note, in 9/15(60%) the site of infection was a right ventricle-pulmonary artery conduit. 7/9 (77.8%) were a Contegra conduit.
Summary Ongoing surveillance of IE is vitally important and our study has revealed an increase in the incidence in our population. The majority of the cases were spontaneous infections. Further analysis will be required to determine if this is an ongoing trend and the causes are likely multifactorial.
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