Key result
Periprocedural antibiotics show no benefit against early infective endocarditis after congenital cardiac catheterization.
Why the study?
Antibiotic prophylaxis practices vary significantly before congenital cardiac catheterizations, and the true incidence of procedure-related infective endocarditis remains unclear.
Does periprocedural antibiotic prophylaxis prevent early postprocedural infective endocarditis in pediatric patients undergoing congenital cardiac catheterization?
Cohort (n=20,580)
Yes
Does periprocedural antibiotic prophylaxis prevent early postprocedural infective endocarditis in pediatric patients undergoing congenital cardiac catheterization?
Routine periprocedural antibiotic prophylaxis for congenital cardiac catheterizations (excluding transcatheter pulmonary valve replacement) may be unnecessary given the exceedingly low incidence of early infective endocarditis and lack of measurable protective effect.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“With only 15 outcomes, the CI around the exposure estimate is wide enough to include clinically meaningful benefit...The paper is most valuable as descriptive epidemiology and as an antimicrobial stewardship map.”
No association seen with prophylaxis and early IE; hypothesis-generating and should not yet change practice in congenital catheterization.
BACKGROUND: There is significant antibiotic prophylaxis (ABP) variability before congenital cardiac catheterization procedures. The true incidence of procedure-related infective endocarditis (IE) remains unclear. OBJECTIVE: This study aimed to evaluate national periprocedural ABP utilization patterns and determine whether ABP dosing strategies are associated with early postprocedural IE. METHODS: A retrospective cohort study was conducted using data from the Pediatric Health Information System from 39 pediatric centers. Data were collected on the following procedures: patent ductus arteriosus (PDA) device occlusion, atrial septal defect device occlusion, ventricular septal defect device occlusion, transcatheter pulmonary valve replacement (TPVR), and pulmonary or aortic balloon valvuloplasty. Outcomes assessed were: 1) rate and pattern of periprocedural antibiotic use and 2) incidence of early IE within 30-days postprocedure. RESULTS: A total of 20,580 procedures were analyzed. Antibiotic dosing varied significantly by procedure, with the proportion of patients receiving ≥2 doses ranging from 38.8% for PDA closure to 85.7% for TPVR. A total of 15 IE cases (0.07%) were identified within 30 days, more than half of which followed TPVR (53%). The incidence of early IE varied significantly by procedure type (P = 0.003): TPVR (0.27%), pulmonary valvuloplasty (0.12%), atrial septal defect closure (0.04%), and PDA closure (0.02%). There was no measurable association between ABP and early IE. CONCLUSIONS: Procedure-related IE is exceedingly rare and is significantly related to procedure type. We did not observe a measurable association between early IE and ABP dosing. These findings underscore the need for standardized, evidence-based guidelines to optimize antibiotic protocols for congenital cardiac catheterization.
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Issa et al. (2026) conducted a cohort in Congenital heart disease requiring cardiac catheterization (n=20,580). Periprocedural antibiotic prophylaxis vs. No antibiotics was evaluated on Early postprocedural infective endocarditis within 30 days (OR 1.59, 95% CI 0.36-7.14, p=0.75). Periprocedural antibiotic prophylaxis was not significantly associated with a reduced risk of early infective endocarditis within 30 days of congenital cardiac catheterization (OR 1.59).
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