Purpose NICE 64 guidelines for endocarditis prophylaxis have resulted in a major shift in historic management1. An audit conducted in 2009 in this institution suggested that over 33% of patients received antibiotics inappropriately. The aim of this study was to conduct a mandated follow-up audit of compliance. Clinicians were questioned about their understanding of the NICE recommendations.
Methods This 18 month study reviewed the management of children with congenital heart disease undergoing a surgical procedure. Patients were identified from hospital surgical and paediatric cardiology databases. Electronic outpatient letters and the case notes of patients who had been under the care of the Paediatrician with expertise in cardiology were reviewed to determine the type of congenital heart disease, surgical procedure and the reason for administration of any peri-operative antibiotics. Knowledge about endocarditis prophylaxis was obtained through a survey monkey questionnaire sent to clinicians.
Results We identified 10370 paediatric surgical patients, 262 children had attended the paediatric cardiology clinic in the last 5 years. Of these, 62 had a diagnosis of CHD according to the NICE criteria and 51 underwent a relevant procedure. 15 received intra-operative antibiotics. All of these were according to routine surgical protocols and none with a view to prophylaxis. There were no cases of endocarditis. 100 questionaire responses were received from doctors ranging from FY1 to consultants. Risk factors for endocarditis were correctly identified. Responses regarding prophylactic antibiotic use showed that treatment would be wrongly initiated in up to 70% of replies.
Conclusion Compliance with the NICE guidance was 100%. The current practice in this paediatric surgical department is in accordance with NICE guidance. This avoids unnecessary exposure to the risk of side effects and drug reactions and minimises development of microbial resistance. The doctors' survey suggests that further education is required around antibiotic prescribing.