There was so significant association between antibiotic prophylaxis (ABP) dosing before congenital cardiac catheterization and early infective endocarditis (IE) post procedure, according to a retrospective analysis recently published in JACC: Advances. Overall, IE was rare and largely dependent on procedure type.

Bayan Issa, MD, et al., reviewed 20,580 procedures from 39 pediatric centers participating in the Pediatric Health Information System. Patients undergoing patent ductus arteriosus (PDA) device occlusion, atrial septal defect device occlusion, ventricular septal defect device occlusion, transcatheter pulmonary valve replacement (TPVR) and pulmonary or aortic balloon valvuloplasty were included. Outcomes of interest were trends in periprocedural antibiotic use and incidence of IE within 30 days post procedure.

The authors noted significant variation in ABP dosing by procedure type. Patients receiving two or more doses of ABP ranged from 39% for PDA closure procedures to 86% for TPVR. The rate of early IE was low (0.07%) and varied by procedure type (p=0.003): TPVR (0.27%), pulmonary valvuloplasty (0.12%), atrial septal defect closure (0.04%) and PDA closure (0.02%). No measurable association between ABP and early IE was observed.

"Given the rarity of early IE in this population, any true association between ABP use and early IE risk may be too subtle for even a large cohort such as ours to reliably detect," state the authors. "Still, the lack of association raises a question about the utility of ABP for all device-related cases. Our findings support reconsideration of routine multidose ABP strategies."

In an accompanying editorial comment, Jack W. McHugh, MB, BCh, BAO; Supavit Chesdachai, MD; and Larry M. Baddour, MD, add: "The central inference should be cautious. This study does not show that ABP is ineffective. With only 15 outcomes, the CI around the exposure estimate is wide enough to include clinically meaningful benefit...The paper is most valuable as descriptive epidemiology and as an antimicrobial stewardship map."