Original articleClinical endoscopyCurrent knowledge of antibiotic prophylaxis guidelines regarding GI open-access endoscopic procedures is inadequate

BackgroundThe American Heart Association (AHA) guidelines from 2007 and the American Society for Gastrointestinal Endoscopy (ASGE) guidelines from 2008 recommended against antibiotic prophylaxis before GI endoscopic procedures to prevent bacterial endocarditis.ObjectiveTo determine physician knowledge regarding these guidelines and to identify physician subgroups for which knowledge was suboptimal.DesignA survey questionnaire was developed based on AHA and ASGE guidelines regarding antibiotics before endoscopy. Physicians were queried about 10 theoretical scenarios as to whether or not they would recommend before-procedure antibiotics.SettingThe survey was administered at 3 academic medical centers.ParticipantsAttending physicians and trainees in primary care and subspecialties.InterventionsSurvey.Main Outcome MeasurementsPercentage of the survey questions answered correctly and predictors of correct response.ResultsThe survey was administered to 941 participants of whom 12 declined to participate. Eighty percent (n = 740/929) of participants completed the survey. The median number of correct answers was 70% (interquartile range [IQR] 50%-90%) and was similar at each institution (P = .6). A total of 7.3% (n = 54) of respondents answered all questions correctly. There was no significant difference in correct responses between attending physicians and trainees or between study centers (median 7, IQR 5-9; P = .75). Gastroenterologists were more likely to answer questions correctly than other subspecialists or primary care physicians (P < .0001). On multivariate analysis, physician knowledge correlated directly with self-reported familiarity with guidelines (0.21; 95% confidence interval [CI], 0.08-0.34; P = .002) and specialty (0.56; 95% CI, 0.30-0.82; P < .001) and inversely with year of medical school graduation (0.22; 95% CI, 0.07-0.37; P = .005).LimitationsSurvey study that used theoretical scenarios.ConclusionPhysician knowledge of guidelines regarding antibiotic use before endoscopy is suboptimal. Further interventions are needed to improve the knowledge of before-procedure guidelines.