Prophylaxis of Infective Endocarditis: A Cross Sectional Survey among Physician Members of the Portuguese Society of Cardiology
DOI:
https://doi.org/10.20344/amp.17379Keywords:
Antibiotic Prophylaxis, Endocarditis, Portugal, Surveys and QuestionnairesAbstract
Introduction: In the last decade, the downgrading of indications for antibiotic prophylaxis for infective endocarditis caused an uncertain impact on the incidence of this condition. Since no data is available on the practice of infective endocarditis prophylaxis in Portugal, we aimed to characterize the pattern of antibiotic use for infective endocarditis prophylaxis and the compliance/awareness of scientific guidelines among physician members of the Portuguese Society of Cardiology.
Material and Methods: A cross sectional observational study was conducted. An online self-completed questionnaire with 12 items on infective endocarditis prophylaxis was sent to 1330 physicians, specialists and residents, members of the Portuguese Society of Cardiology. In addition, descriptive statistical analysis was performed.
Results: Two hundred and fifty-three valid questionnaires were responded. Eighty-seven per cent of respondents were cardiologists (specialists or residents), mostly between 30 and 40 years old (26.7%) and 50 to 80 years old (44.3%). The majority (83.0%) follow the European scientific guidelines. Still, 61.0% had or may have had doubts regarding prophylaxis of infective endocarditis in certain patients. Variable adherence to scientific guidelines was noted. Further scientific evidence was required by 60.6% of respondents.
Conclusion: Infective endocarditis prophylaxis was generally guided by European scientific guidelines among physicians of the Portuguese Society of Cardiology. There was, however, an evident discrepancy between the guidelines and real-world perception of the risk of infective endocarditis. This highlights the sensed gap in accessing more robust scientific evidence.
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References
Cahill TJ, Baddour LM, Habib G, Hoen B, Salaun E, Pettersson GB, et al. Challenges in infective endocarditis. J Am Coll Cardiol. 2017;69:325–44. DOI: https://doi.org/10.1016/j.jacc.2016.10.066
Bin Abdulhak AA, Baddour LM, Erwin PJ, Hoen B, Chu VH, Mensah GA, et al. Global and regional burden of infective endocarditis, 1990-2010: a systematic review of the literature. Glob Heart 2014;9:131–43. DOI: https://doi.org/10.1016/j.gheart.2014.01.002
Murdoch DR, Corey GR, Hoen B, Miro J, Fowler V, Bayer A, et al. Clinical presentation, etiology and outcome of infective endocarditis in the 21st century: the international collaboration on endocarditis-prospective cohort study. Ann Intern Med. 2009;169:463–73. DOI: https://doi.org/10.1001/archinternmed.2008.603
Habib G, Erba PA, Iung B, Donal E, Cosyns B, Laroche C, et al. Clinical presentation, aetiology and outcome of infective endocarditis. Results of the ESC-EORP EURO-ENDO (European infective endocarditis) registry: a prospective cohort study. Eur Heart J. 2019;40:3222–32. DOI: https://doi.org/10.1093/eurheartj/ehz620
Lewis T, Grant R. Observations relating to subacute infective endocarditis. Heart. 1923;10:21-77.
Elliott SD. Bacteriæmia and oral sepsis. Proc R Soc Med. 1939;32:747–54. DOI: https://doi.org/10.1177/003591573903200712
Hilson GR. Is chemoprophylaxis necessary? Proc Roy Soc Med. 1970;63:267–71. DOI: https://doi.org/10.1177/003591577006300321
Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, et al. 2015 ESC guidelines for the management of infective endocarditis. Eur Heart J. 2015;36:3075–128. DOI: https://doi.org/10.1093/eurheartj/ehv319
Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM, Levison M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association. Circulation. 2007;116:1736-54. DOI: https://doi.org/10.1161/CIRCULATIONAHA.106.183095
Dayer MJ, Chambers JB, Prendergast B, Sandoe JA, Thornhill MH. NICE guidance on antibiotic prophylaxis to prevent infective endocarditis: a survey of clinicians’ attitudes. QJM. 2013;106:237–43. DOI: https://doi.org/10.1093/qjmed/hcs235
Tarasoutchi F, Montera M, Grinberg M, Barbosa M, Piñeiro D, Sánchez C, et al. Diretriz brasileira de valvopatias - SBC 2011/ I Diretriz interamericana de valvopatias - SIAC 2011. Arq Bras Cardiol. 2011;97:1-67. DOI: https://doi.org/10.1590/S0066-782X2011002000001
Torres F, Renilla A, Florez J, Secades S, Benito E, de la Hera J. Knowledge of infective endocarditis and prophylaxis among Spanish dentists. Rev Esp Cardiol. 2012;65:1134–5. DOI: https://doi.org/10.1016/j.rec.2012.04.007
Cloitre A, Duval X, Hoen B, Alla F. A nationwide survey of French dentists’ knowledge and implementation of current guidelines for antibiotic prophylaxis of infective endocarditis in patients with. Oral Surg Oral Med Oral Pathol Oral Radiol. 2018;125:295–303. DOI: https://doi.org/10.1016/j.oooo.2017.10.002
Khan O, Shafi AM, Timmis A. International guideline changes and the incidence of infective endocarditis: a systematic review. Open Heart. 2016;3:e000498. DOI: https://doi.org/10.1136/openhrt-2016-000498
Keller K, Bardeleben RS Von, Ostad MA, Hobohm L, Munzel T, Konstantinides S, et al. Temporal trends in the prevalence of infective endocarditis in Germany between 2005 and 2014. Am J Cardiol. 2017;119:317–22. DOI: https://doi.org/10.1016/j.amjcard.2016.09.035
Dayer MJ, Jones S, Prendergast B, Baddour LM, Lockhart PB, Thornhill MH. Incidence of infective endocarditis in England, 2000-13: a secular trend, interrupted time-series analysis. Lancet. 2015;385:1219–28.
Sousa C, Nogueira P, Pinto FJ. Insight into the epidemiology of infective endocarditis in Portugal: a contemporary nationwide study from 2010 to 2018. BMC Cardiovasc Disord. 2021;21:138. DOI: https://doi.org/10.1186/s12872-021-01937-3
de Sousa C, Ribeiro RM, Pinto FJ. The burden of infective endocarditis in Portugal in the last 30 years – a systematic review of observational studies. Rev Port Cardiol. 2021;40:205–17. DOI: https://doi.org/10.1016/j.repc.2020.07.014
Abdulaziz K, Brehaut J, Taljaard M, Émond M, Sirois MJ, Lee JS, et al. National survey of physicians to determine the effect of unconditional incentives on response rates of physician postal surveys. BMJ Open. 2015;5:1–6. DOI: https://doi.org/10.1136/bmjopen-2014-007166
Baddour LM, Wilson WR, Bayer AS, Fowler VG, Tleyjeh IM, Rybak MJ, et al. Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications: a scientific statement for healthcare professionals from the American Heart Association. Circulation. 2015;132:1435–86. DOI: https://doi.org/10.1161/CIR.0000000000000296
Metcalfe D, Pitkeathley C, Herring J. ‘Advice, not orders’? The evolving legal status of clinical guidelines. J Med Ethics. 2020;medethics-2020-106592. doi: 10.1136/medethics-2020-106592. DOI: https://doi.org/10.1136/medethics-2020-106592
National Institute for Health and Care Excellence. Prophylaxis against infective endocarditis: antimicrobial prophylaxis against infective endocarditis in adults and children undergoing interventional procedures. 2008. [cited 2019 May 16]. Available from: https://www.nice.org.uk/guidance/cg64.
Habib G, Hoen B, Tornos P, Thuny F, Prendergast B, Vilacosta I, et al. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): The Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC). Eur Heart J. 2009;30:2369–413. DOI: https://doi.org/10.1093/eurheartj/ehp285
Dayer MJ, Jones S, Prendergast B, Baddour LM, Lockhart PB, Thornhill MH. An increase in the incidence of infective endocarditis in England since 2008: a secular trend interrupted time series analysis. Lancet. 2015;385:1219–28. DOI: https://doi.org/10.1016/S0140-6736(14)62007-9
Van Den Brink FS, Swaans MJ, Hoogendijk MG, Alipour A, Kelder JC, Jaarsma W, et al. Increased incidence of infective endocarditis after the 2009 European Society of Cardiology guideline update: a nationwide study in the Netherlands. Eur Hear J Qual Care Clin Outcomes. 2017;3:141–7. DOI: https://doi.org/10.1093/ehjqcco/qcw039
Cahill TJ, Harrison JL, Jewell P, Onakpoya I, Chambers JB, Dayer M, et al. Antibiotic prophylaxis for infective endocarditis: a systematic review and meta-analysis. Heart. 2017;103:937–44. DOI: https://doi.org/10.1136/heartjnl-2015-309102
Grattan MJ, Power A, Fruitman DS, Islam S, Mackie AS. The impact of infective endocarditis prophylaxis recommendations on the practices of pediatric and adult congenital cardiologists. J Cardiol. 2015;31:1497. e23-8. DOI: https://doi.org/10.1016/j.cjca.2015.04.032
Pharis CS, Conway J, Warren AE, Bullock A, MacKie AS. The impact of 2007 infective endocarditis prophylaxis guidelines on the practice of congenital heart disease specialists. Am Heart J. 2011;161:123–9. DOI: https://doi.org/10.1016/j.ahj.2010.09.024
Armstrong ML, DeBoer S, Cetta F. Infective endocarditis after body art: a review of the literature and concerns. J Adolesc Health. 2008;43:217–25. DOI: https://doi.org/10.1016/j.jadohealth.2008.02.008
Thornhill MH, Jones S, Prendergast B, Baddour LM, Chambers JB, Lockhart PB, et al. Quantifying infective endocarditis risk in patients with predisposing cardiac conditions. Eur Heart J. 2018;39:586–95. DOI: https://doi.org/10.1093/eurheartj/ehx655
Sun YP, O’Gara PT. Cardiovascular conditions predisposing to infective endocarditis: time to reconsider the current risk classification system? Eur Heart J. 2018;39:596–8. DOI: https://doi.org/10.1093/eurheartj/ehx797
Everett E, Hirschmann J. Transient bacteriemia and endocarditis prophylaxis. a review. Medicine. 1977;56:61–77. DOI: https://doi.org/10.1097/00005792-197756010-00004
Lockhart PB, Brennan MT, Sasser HC, Fox PC, Paster BJ, Bahrani-Mougeot FK. Bacteremia associated with toothbrushing and dental extraction. Circulation. 2008;117:3118–25. DOI: https://doi.org/10.1161/CIRCULATIONAHA.107.758524
Holland TL, Baddour LM, Bayer AS, Hoen B, Miro JM, Fowler VG. Infective endocarditis. Nat Rev Dis Prim. 2017;2:1–49. DOI: https://doi.org/10.1038/nrdp.2016.59
McFarlane E, Olmsted MG, Murphy J, Hill CA. Nonresponse bias in a mail survey of physicians. Eval Heal Prof. 2007;30:170–85. DOI: https://doi.org/10.1177/0163278707300632
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