Gr. Zuckerman et al., ANTIBIOTIC-PROPHYLAXIS IN PATIENTS WITH INFECTIOUS RISK-FACTORS UNDERGOING GASTROINTESTINAL ENDOSCOPIC PROCEDURES, Gastrointestinal endoscopy, 40(5), 1994, pp. 538-543
Consecutive patients undergoing gastrointestinal endoscopic procedures
were prospectively evaluated for the presence of risk factors for the
development of infectious complications that indicated a need for pro
phylactic antibiotics. Criteria for the evaluation of risk factors wer
e based on (a) former American Heart Association guidelines, (b) curre
nt American Heart Association guidelines, and (c) American Society for
Gastrointestinal Endoscopy guidelines. Four hundred eighty-six patien
ts underwent 507 procedures. Risk factors for the development of endoc
arditis or other infectious complications were found in 74 (15%) of al
l patients during the study period. Cardiac conditions in 51 patients
were the most frequently encountered risk factor (69% of risk factors,
10% of all patients), with mitral valve prolapse in 25 patients accou
nting for 49% of patients with cardiac risk factors and 5% of all pati
ents. Of the patients with mitral valve prolapse, 7 (28%, 1.4% of all
study patients) had associated valvular regurgitation. None of the pat
ients with mitral valve prolapse knew whether or not they had associat
ed valvular regurgitation, and if they had had a previous echocardiogr
am, they were unaware of the results. Only 0.8% of patients had a pros
thetic heart valve. The most common non-cardiac risk factor was the pr
esence of a prosthetic joint (9 of 486, 1.8%). Of the 486 patients, 14
required antibiotic prophylaxis according to the above-mentioned guid
elines. Six of the 14 patients were given either a non-recommended ant
ibiotic or the wrong dose of a recommended antibiotic. Conclusions: (1
) A decision regarding whether to administer antibiotic prophylaxis ha
d to be made in 15% of patients undergoing endoscopy. (2) Depending on
which set of guidelines were followed, only 1% to 3% of patients requ
ired antibiotics. (3) Of the risk factors for infection, mitral valve
prolapse was the most frequently encountered (5%), but the ''true'' ri
sk of mitral valve prolapse with valvular regurgitation was frequently
obscure and was documented for only 28% of patients with mitral valve
prolapse. (4) The most frequently encountered management problem was
the prescribing of a non-recommended antibiotic or of an incorrect dos
e of a recommended antibiotic (43% of patients given prophylactic anti
biotics).