title: Trends in endocarditis hospitalizations at US children's hospitals: impact of the 2007 American Heart Association Antibiotic Prophylaxis Guidelines.
abstract: BACKGROUND
  In 2007, the American Heart Association recommended cessation of antibiotic prophylaxis for infective endocarditis (IE) before dental procedures for all but those at highest risk for adverse outcomes from IE. The impact of these guidelines is unclear. We evaluated IE hospitalizations at US children's hospitals during this period.
  
  
  METHODS
  Children <18 years old hospitalized from 2003 to 2010 with IE at 37 centers in the Pediatric Health Information Systems Database were included. Using Poisson regression, we evaluated the number IE hospitalizations over time (raw and indexed to total hospital admissions).
  
  
  RESULTS
  A total of 1157 IE cases were identified; 68% had congenital heart disease (CHD). The raw number of IE cases did not change significantly over time (+1.6% difference post vs pre guidelines, 95% CI -6.4% to +10.3%, P = .7). When the number of IE cases was indexed per 1,000 hospital admissions, there was a significant decline during the time period before the guidelines (annual change: -5.9%, 95% CI -9.9 to -1.8, P = .005) and a similar decline in the post guidelines period such that the difference between the 2 periods was not significant (P = .15). In subgroup analysis, no significant change over time in IE cases (raw or indexed) was found in the CHD subset, those 5 to 18 years old (subgroup most likely receiving dental care), or in cases coded as oral streptococci.
  
  
  CONCLUSIONS
  We found no evidence that release of new antibiotic prophylaxis guidelines was associated with a significant change in IE admissions across 37 US children's hospitals.
authors.affiliation: Division of Cardiology, Department of Pediatrics, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27715, USA. sara.pasquali@duke.edu
authors.forename: Sara K
authors.initials: SK
authors.lastname: Pasquali
authors.forename: Xia
authors.initials: X
authors.lastname: He
authors.forename: Zeinab
authors.initials: Z
authors.lastname: Mohamad
authors.forename: Brian W
authors.initials: BW
authors.lastname: McCrindle
authors.forename: Jane W
authors.initials: JW
authors.lastname: Newburger
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Li
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D000572:American Heart Association; D019072:Antibiotic Prophylaxis / Q000592:standards*; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D004697:Endocarditis, Bacterial / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data / Q000639:trends*; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D017410:Practice Guidelines as Topic / Q000592:standards*; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D014481:United States / Q000453:epidemiology