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Trends in infective endocarditis hospitalisations at United States children’s hospitals from 2003 to 2014: impact of the 2007 American Heart Association antibiotic prophylaxis guidelines

  • Katherine E. Bates (a1), Matthew Hall (a2), Samir S. Shah (a3), Kevin D. Hill (a4) and Sara K. Pasquali (a1)...



National organisations in several countries have recently released more restrictive guidelines for infective endocarditis prophylaxis, including the American Heart Association 2007 guidelines. Initial studies demonstrated no change in infective endocarditis rates over time; however, a recent United Kingdom study suggested an increase; current paediatric trends are unknown.


Children (<18 years) hospitalised with infective endocarditis at 29 centres participating in the Pediatric Health Information Systems Database from 2003 to 2014 were eligible for inclusion. Our primary analysis focussed on infective endocarditis most directly related to the change in guidelines and included community-acquired cases in those >5 years of age. Interrupted time series analysis was used to evaluate rates over time indexed to total hospitalisations.


A total of 841 cases were identified. The median age was 13 years (interquartile range 9–15 years). In the pre-guideline period, there was a slight increase in the rate of infective endocarditis by 0.13 cases/10,000 hospitalisations per semi-annual period. In the post-guideline period, the rate of infective endocarditis increased by 0.12 cases/10,000 hospitalisations per semi-annual period. There was no significant difference in the rate of change in the pre- versus post-guidelines period (p=0.895). Secondary analyses in children >5 years of age with CHD and in children hospitalised with any type of infective endocarditis at any age revealed similar results.


We found no significant change in infective endocarditis hospitalisation rates associated with revised prophylaxis guidelines over 11 years across 29 United States children’s hospitals.


Corresponding author

Correspondence to: K. E. Bates, MD, Congenital Heart Center, C.S. Mott Children’s Hospital, University of Michigan Medical School, 1540 E. Hospital Drive, Ann Arbor, MI 48109, United States of America. Tel: 734 936 2537; Fax: 734 936 4628; E-mail:


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1. National Institute for Health and Care Excellence. Prophylaxis against infective endocarditis. Retrieved January 4, 2016, from
2. Habib, G, Hoen, B, Tornos, P, 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: 23692413.
3. Danchin, N. Prophylaxis of infective endocarditis: French recommendations 2002. Heart 2005; 91: 715718.
4. Wilson, W, Taubert, KA, Gewitz, M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation 2007; 116: 17361754.
5. Duval, X, Delahaye, F, Alla, F, et al. Temporal trends in infective endocarditis in the context of prophylaxis guideline modifications. J Am Coll Cardiol 2012; 59: 19681976.
6. DeSimone, DC, Tleyjeh, IM, Correa de Sa, DD, et al. Incidence of infective endocarditis caused by viridans group streptococci before and after publication of the 2007 American Heart Association’s endocarditis prevention guidelines. Circulation 2012; 126: 6064.
7. Bikdeli, B, Wang, Y, Kim, N, Desai, MM. Trends in hospitalization rates and outcomes of endocarditis among Medicare beneficiaries. J Am Coll Cardiol 2013; 62: 22172226.
8. Thornhill, MH, Dayer, MJ, Forde, JM, et al. Impact of the NICE guideline recommending cessation of antibiotic prophylaxis for prevention of infective endocarditis: before and after study. BMJ 2011; 342: d2392.
9. Pasquali, SK, He, X, Mohamad, Z, et al. Trends in endocarditis hospitalizations at US children’s hospitals: impact of the 2007 American Heart Association antibiotic prophylaxis guidelines. Am Heart J 2012; 163: 894899.
10. 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: 12191228.
11. Pant, S, Patel, NJ, Deshmukh, A, et al. Trends in infective endocarditis incidence, microbiology, and valve replacement in the United States from 2000 to 2011. J Am Coll Cardiol 2015; 65: 20702076.
12. Morse, RB, Hall, M, Fieldston, ES, et al. Children’s hospitals with shorter lengths of stay do not have higher readmission rates. J Pediatr 2013; 163: 10341038.
13. Berry, JG, Hall, DE, Kuo, DZ, et al. Hospital utilization and characteristics of patients experiencing recurrent readmissions within children’s hospitals. JAMA 2011; 305: 682690.
14. Pasquali, SK, Li, JS, He, X, et al. Perioperative methylprednisolone and outcome in neonates undergoing heart surgery. Pediatrics 2012; 129: e385e391.
15. Baddour, LM, Wilson, WR, Bayer, AS, et al. Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. Circulation 2005; 111: e394e434.
16. Jenkins, KJ, Gauvreau, K, Newburger, JW, Spray, TL, Moller, JH, Iezzoni, LI. Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg 2002; 123: 110118.
17. 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: 123129.
18. Naik, RJ, Patel, NR, Wang, M, Shah, NC. Infective endocarditis prophylaxis: current practice trend among paediatric cardiologists: are we following the 2007 guidelines? Cardiol Young 2015; 93: 17.



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