Skip to main content

Advertisement

Log in

Endocarditis prophylaxis in daily practice of pediatricians and dentists in Flanders

  • Original Article
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Endocarditis is a potentially life-threatening disease in children with congenital heart disease (CHD) and correct prophylaxis (EP) is of utmost importance. We conducted two surveys among pediatricians and dentists in Flanders about their knowledge of EP guidelines. The survey was completed by 910 dentists and 100 pediatricians. Sixty-five percent of the dentists did not know any guideline. They relied for information on the internet or the child’s physician. 87% identified low risk treatments correctly, but only 64% identified high risk procedures correctly. Eighty-three percent asked for the presence of CHD and allergy to antibiotics. Dentists asked advice of the patient’s physician, but 29% would withhold treatments in high-risk patients and 50% did not know the pediatric antibiotic dosages. Forty-seven percent of the pediatricians did not know EP guidelines and they would preferably contact the child’s cardiologist. Pediatricians had difficulties with the identification of low-risk procedures and would give unnecessary antibiotics. They identified most CHD at high risk, but scored lower for the identification of lower risk CHD.

Conclusion: The knowledge of Flemish dentists and pediatricians of EP guidelines is low. The knowledge about EP guidelines and the communication between dentists and pediatricians should be improved. Patients should be provided with an individual EP card.

What is Known:

The knowledge of dentists and cardiologists about EP is not perfect, which has already been described.

There are several guidelines about EP, and they are not identical and sometimes confusing.

What is New:

This is the first article combining large scale surveys of the knowledge and application of EP by dentists and pediatricians, allowing us to compare knowledge and gaps of knowledge and use their complementarity in order to offer tailored solutions and use patient education and partnership

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

Abbreviations

AHA:

American Heart Association

CC:

Congenital cardiologist

CHD:

Congenital heart disease

D:

Dentist

ESC:

European Society of Cardiology

EP:

Endocarditis prophylaxis

IE:

Infectious endocarditis

NICE:

The National Institute for Health and Clinical Excellence

P:

Pediatrician

References

  1. Mulder BJ (2013) Endocarditis in congenital heart disease: who is at highest risk? Circulation 128:1396–1397

    Article  Google Scholar 

  2. Pasquali SK, He X, Mohamad Z, McCrindle BW, Newburger JW, Li JS, Shah SS (2012) Trends in endocarditis hospitalizations at US children's hospitals: impact of the 2007 AHA Antibiotic Prophylaxis Guidelines. Am Heart J 163:894–899

    Article  Google Scholar 

  3. Prendergast BD (2006) The changing face of infective endocarditis. Heart 92:879–885

    Article  CAS  Google Scholar 

  4. Rushani D, Kaufman JS, Ionescu-Ittu R, Mackie AS, Pilote L, Therrien J, Marelli AJ (2013) Infective endocarditis in children with CHD: cumulative incidence and predictors. Circulation 128:1412–1419

    Article  Google Scholar 

  5. Martin J, Lindgren C (2018) Infectious endocarditis prophylaxis in children. Pediatr Emerg Care 34:743–746

    Article  Google Scholar 

  6. Day MD, Gauvreau K, Shulman S, Newburger JW (2009) Characteristics of children hospitalized with infective endocarditis. Circulation 119:865–870

    Article  Google Scholar 

  7. Dayer M, Thornhill M (2018) Is antibiotic prophylaxis to prevent infective endocarditis worthwhile? J Infect Chemother 24:18–24

    Article  Google Scholar 

  8. Dayer MJ, Jones S, Prendergast B, Baddour LM, Lockhart PB, Thornhill MH (2015) Incidence of infective endocarditis in England, 2000-13: a secular trend, interrupted time-series analysis. Lancet 385:1219–1228

    Article  Google Scholar 

  9. Forner L, Larsen T, Kilian M, Holmstrup P (2006) Incidence of bacteremia after chewing, tooth brushing and scaling in individuals with periodontal inflammation. J Clin Periodontol 33:401–407

    Article  Google Scholar 

  10. Lockhart PB, Brennan MT, Sasser HC, Fox PC, Paster BJ, Bahrani-Mougeot FK (2008) Bacteremia associated with toothbrushing and dental extraction. Circulation 117:3118–3125

    Article  CAS  Google Scholar 

  11. Cahill TJ, Harrison JL, Jewell P, Onakpoya I, Chambers JB, Dayer M, Lockhart P, Roberts N, Shanson D, Thornhill M, Heneghan CJ, Prendergast BD (2017) Antibiotic prophylaxis for infective endocarditis: a systematic review and meta-analysis. Heart 103:937–944

    Article  CAS  Google Scholar 

  12. Daly CG (2017) Antibiotic prophylaxis for dental procedures. Aust Prescr 40:184–188

    Article  Google Scholar 

  13. Thornhill MH, Dayer M, Lockhart PB, McGurk M, Shanson D, Prendergast B, Chambers JB (2016) Guidelines on prophylaxis to prevent infective endocarditis. Br Dent J 220:51–56

    Article  CAS  Google Scholar 

  14. Baltimore RS, Gewitz M, Baddour LM, Beerman LB, Jackson MA, Lockhart PB, Pahl E, Schutze GE, Shulman ST, Willoughby R Jr (2015) Infective endocarditis in childhood: 2015 update. Circulation 132:1487–1515

    Article  Google Scholar 

  15. Centre for Clinical Practice at N (2008) National Institute for health and clinical excellence: guidance. Prophylaxis Against Infective Endocarditis: Antimicrobial Prophylaxis Against Infective Endocarditis in Adults and Children Undergoing Interventional Procedures. National Institute for Health and Clinical Excellence, London

    Google Scholar 

  16. Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, Dulgheru R, El Khoury G, Erba PA, Iung B, Miro JM, Mulder BJ, Plonska-Gosciniak E, Price S, Roos-Hesselink J, Snygg-Martin U, Thuny F, Tornos Mas P, Vilacosta I, Zamorano JL (2015) 2015 ESC guidelines for the management of infective endocarditis. Eur Heart J 36:3075–3128

    Article  Google Scholar 

  17. Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM, Levison M, Bolger A, Cabell CH, Takahashi M, Baltimore RS, Newburger JW, Strom BL, Tani LY, Gerber M, Bonow RO, Pallasch T, Shulman ST, Rowley AH, Burns JC, Ferrieri P, Gardner T, Goff D, Durack DT (2007) Prevention of infective endocarditis: guidelines from the AHA. Circulation 116:1736–1754

    Article  Google Scholar 

  18. Cahill TJ, Prendergast BD (2016) Infective endocarditis. Lancet 387:882–893

    Article  Google Scholar 

  19. Pharis CS, Conway J, Warren AE, Bullock A, Mackie AS (2011) The impact of 2007 infective endocarditis prophylaxis guidelines on the practice of CHD specialists. Am Heart J 161:123–129

    Article  Google Scholar 

  20. Thornhill MH, Dayer M, Lockhart PB, Prendergast B (2017) Antibiotic prophylaxis of infective endocarditis. Curr Infect Dis Rep 19:9

    Article  Google Scholar 

  21. Franklin M, Wailoo A, Dayer MJ, Jones S, Prendergast B, Baddour LM, Lockhart PB, Thornhill MH (2016) The cost-effectiveness of antibiotic prophylaxis for patients at risk of infective endocarditis. Circulation 134:1568–1578

    Article  Google Scholar 

  22. Keller K, Hobohm L, Munzel T, Ostad MA (2019) Incidence of infective endocarditis before and after the guideline modification regarding a more restrictive use of prophylactic antibiotics therapy in the USA and Europe. Minerva Cardioangiol 67:200–206

    Article  Google Scholar 

  23. Miermans P, Durand C, Delvaux A, Jouck P, Steinberg P, Vivet V (2019) Artsen-specialisten in de Pediatrie op de arbeidsmarkt. In: Gezondheidszorg D (ed) FOD Volksgezondheid. Veiligheid van de Voedselketen en Leefmilieu, Brussels, pp 2004–2016

    Google Scholar 

  24. Vivet V, Delvaux A, Durand C, Jouck P, Miermans P, Steinberg P (2019) Tandartsen (totaal specialisaties) op de arbeidsmarkt. In: Gezondheidszorg D (ed) FOD Volksgezondheid. Veiligheid van de Voedselketen en Leefmilieu, Brussels, pp 2004–2016

    Google Scholar 

  25. Cloitre A, Duval X, Hoen B, Alla F, Lesclous P (2018) A nationwide survey of French dentists' knowledge and implementation of current guidelines for antibiotic prophylaxis of infective endocarditis in patients with predisposing cardiac conditions. Oral Surg Oral Med Oral Pathol Oral Radiol 125:295–303

    Article  Google Scholar 

  26. Nomura R, Kokomoto K, Ohara T, Nakatani S, Ooshima T, Nakano K (2018) Current knowledge among Japanese experienced general dentists regarding prevention of infective endocarditis. Odontology 106:297–305

    Article  Google Scholar 

  27. Chate RA (2008) An infective endocarditis audit illustrates why dental guidelines in general need to be kept clear, simple and unambiguous. Br Dent J 205:331–335

    Article  CAS  Google Scholar 

  28. Hafner S, Albittar M, Abdel-Kahaar E, Zolk O (2020) Antibiotic prophylaxis of infective endocarditis in oral and maxillofacial surgery: incomplete implementation of guidelines in everyday clinical practice. Int J Oral Maxillofac Surg 49:522–528

    Article  CAS  Google Scholar 

  29. Jain P, Stevenson T, Sheppard A, Rankin K, Compton SM, Preshing W, Anderson R, Islam S, Mackie AS (2015) Antibiotic prophylaxis for infective endocarditis: knowledge and implementation of AHA guidelines among dentists and dental hygienists in Alberta, Canada. J Am Dent Assoc 146:743–750

    Article  Google Scholar 

  30. Kokomoto K, Nomura R, Ohara T, Nakatani S, Ooshima T, Nakano H (2018) Current knowledge among pediatric dentistry specialists in Japan regarding prevention of infective endocarditis. Pediatr Dent J 28:110–117

    Article  Google Scholar 

  31. Naik RJ, Patel NR, Wang M, Shah NC (2016) Infective endocarditis prophylaxis: current practice trend among paediatric cardiologists: are we following the 2007 guidelines? Cardiol Young 26:1176–1182

    Article  Google Scholar 

  32. Patel J, Kupferman F, Rapaport S, Kern JH (2014) Preprocedure prophylaxis against endocarditis among United States pediatric cardiologists. Pediatr Cardiol 35:1220–1224

    Article  Google Scholar 

  33. Bahammam MA, Abdelaziz NM (2015) Awareness of antimicrobial prophylaxis for infective endocarditis among dental students and interns at a teaching Hospital in Jeddah, Saudi Arabia. Open Dent J 9:176–180

    Article  Google Scholar 

  34. Cloitre A, Lesclous P, Trochu Q, Selton-Suty C, Boutoille D, Le Tourneau T, Delahaye F, Thomas D, Iung B, Gaudin A, Duval X, Trochu JN (2020) Antibiotic prophylaxis of infective endocarditis in patients with predisposing cardiac conditions: French cardiologists' implementation of current guidelines. Int J Cardiol 299:222–227

    Article  CAS  Google Scholar 

  35. Castillo F, Castillo JC, Anguita P, Roldan R, Gamez P, Anguita M (2017) Do we follow recommendations on infective endocarditis prophylaxis? Differences between the health professionals involved. Aten Primaria 49:198–200

    Article  Google Scholar 

  36. Choudhry NK, Fletcher RH, Soumerai SB (2005) Systematic review: the relationship between clinical experience and quality of health care. Ann Intern Med 142:260–273

    Article  Google Scholar 

  37. Strand N (2011) Oral health and congenital heart disease. master thesis, University of Oslo, Oslo

Download references

Author information

Authors and Affiliations

Authors

Contributions

DDW supervised the conception and design of the work; the acquisition, analysis, interpretation of data, drafted the work, and revised it critically for important intellectual content; made the definitive version.AG made substantial contributions to the conception and design of the work; the acquisition, analysis, interpretation of data, drafted the work, and revised it critically for important intellectual content.CS made substantial contributions to the conception and design of the work; the acquisition, analysis, interpretation of data, drafted the work, and revised it critically for important intellectual content.AV made substantial contributions to the conception and design of the work; the acquisition, analysis, interpretation of data, drafted the work, and revised it critically for important intellectual content.NV made substantial contributions to the conception and design of the work; the acquisition, analysis, interpretation of data, drafted the work, and revised it critically for important intellectual content.KDG supervised the design of the work and the acquisition, analysis, interpretation of data, drafted the work, and revised it critically for important intellectual content. LM supervised the design of the work and the acquisition, analysis, interpretation of data, drafted the work, and revised it critically for important intellectual content.

Corresponding author

Correspondence to Daniel De Wolf.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study

Additional information

Communicated by Peter de Winter

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(DOCX 18 kb)

ESM 2

(DOCX 19 kb)

ESM 3

(DOCX 13 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

De Wolf, D., Genouw, A., Standaert, C. et al. Endocarditis prophylaxis in daily practice of pediatricians and dentists in Flanders. Eur J Pediatr 180, 397–405 (2021). https://doi.org/10.1007/s00431-020-03769-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-020-03769-3

Keywords

Navigation