The use of antibiotic prophylaxis in radiology departments for patients at high-risk of infective endocarditis.

Patients with a prosthetic heart valve, or a history of endocarditis are at particular risk of developing infective endocarditis during a bacteraemia which may follow many gastrointestinal and genito-urinary radiological procedures. The current British Society for Antimicrobial Chemotherapy guidelines (1992) do recommend antibiotic prophylaxis for these high-risk patients prior to instrumentation of the gastrointestinal or genito-urinary tracts. Routine antibiotic prophylaxis for patients with damaged native valves or heart murmurs is recommended prior to dental procedures only. A questionnaire enquiring about prescribing practice prior to several radiological investigations known to be associated with bacteraemia was sent to 192 radiology departments and 126 replied. Only 38 of the 126 respondents have a prescribing policy for antibiotic prophylaxis in high-risk groups. Fifty-eight departments employ antibiotic prophylaxis prior to one or more of the procedures named in the questionnaire, but only 30 of these have mechanisms for identifying at-risk patients. Forty-eight departments keep recommended antibiotics in the department.