title: Current knowledge of antibiotic prophylaxis guidelines regarding GI open-access endoscopic procedures is inadequate.
abstract: BACKGROUND
  The American Heart Association (AHA) guidelines from 2007 and the American Society for Gastrointestinal Endoscopy (ASGE) guidelines from 2008 recommended against antibiotic prophylaxis before GI endoscopic procedures to prevent bacterial endocarditis.
  
  
  OBJECTIVE
  To determine physician knowledge regarding these guidelines and to identify physician subgroups for which knowledge was suboptimal.
  
  
  METHODS
  A survey questionnaire was developed based on AHA and ASGE guidelines regarding antibiotics before endoscopy. Physicians were queried about 10 theoretical scenarios as to whether or not they would recommend before-procedure antibiotics.
  
  
  METHODS
  The survey was administered at 3 academic medical centers.
  
  
  METHODS
  Attending physicians and trainees in primary care and subspecialties.
  
  
  METHODS
  Survey.
  
  
  METHODS
  Percentage of the survey questions answered correctly and predictors of correct response.
  
  
  RESULTS
  The survey was administered to 941 participants of whom 12 declined to participate. Eighty percent (n=740/929) of participants completed the survey. The median number of correct answers was 70% (interquartile range [IQR] 50%-90%) and was similar at each institution (P=.6). A total of 7.3% (n=54) of respondents answered all questions correctly. There was no significant difference in correct responses between attending physicians and trainees or between study centers (median 7, IQR 5-9; P=.75). Gastroenterologists were more likely to answer questions correctly than other subspecialists or primary care physicians (P<.0001). On multivariate analysis, physician knowledge correlated directly with self-reported familiarity with guidelines (0.21; 95% confidence interval [CI], 0.08-0.34; P=.002) and specialty (0.56; 95% CI, 0.30-0.82; P<.001) and inversely with year of medical school graduation (0.22; 95% CI, 0.07-0.37; P=.005).
  
  
  CONCLUSIONS
  Survey study that used theoretical scenarios.
  
  
  CONCLUSIONS
  Physician knowledge of guidelines regarding antibiotic use before endoscopy is suboptimal. Further interventions are needed to improve the knowledge of before-procedure guidelines.
authors.affiliation: Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Joseph David
authors.initials: JD
authors.lastname: Feuerstein
authors.affiliation: Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Sethi
authors.affiliation: Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Elliot B
authors.initials: EB
authors.lastname: Tapper
authors.affiliation: Department of Medicine, University of Massachusetts Memorial Medical Center, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
authors.forename: Edward
authors.initials: E
authors.lastname: Belkin
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Lewandowski
authors.affiliation: Department of Medicine and Division of Gastroenterology, University of Washington, University of Washington School of Medicine, Seattle, Washington, USA.
authors.forename: Anand
authors.initials: A
authors.lastname: Singla
authors.affiliation: Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Sunil G
authors.initials: SG
authors.lastname: Sheth
authors.affiliation: Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Mandeep
authors.initials: M
authors.lastname: Sawhney
mesh_terms: D000046:Academic Medical Centers; D019072:Antibiotic Prophylaxis / Q000592:standards*; D002983:Clinical Competence / Q000592:standards*; D004504:Education, Medical, Undergraduate; D016099:Endoscopy, Gastrointestinal / Q000592:standards*; D005194:Family Practice; D005762:Gastroenterology; D005853:Geriatrics; D007722:Health Knowledge, Attitudes, Practice; D064416:Hospital Medicine; D006801:Humans; D007388:Internal Medicine; D007396:Internship and Residency; D010820:Physicians; D017410:Practice Guidelines as Topic; D011795:Surveys and Questionnaires; D013997:Time Factors