ANTIBIOTIC-PROPHYLAXIS IN PATIENTS WITH INFECTIOUS RISK-FACTORS UNDERGOING GASTROINTESTINAL ENDOSCOPIC PROCEDURES

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).