Preoperative antibiotics and cardiovascular implantable electronic device infection: A cohort study in veterans

Alzahrani, Talal; Liappis, Angelike P.; Baddour, Larry M.; Karasik, Pamela

doi:10.1111/pace.13499

Cited by 5 publications

(3 citation statements)

References 40 publications

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“…10 Our findings contrast with RCT data demonstrating a lack of benefit of routine post-operative prophylactic antibiotic use. 2,3 Moreover, as seen in a large cohort trial of veterans conducted by Alzahrani et al, 11 appropriate selection of antibiotics for post-implantation use is important in preventing adverse outcomes, as their data suggested that use of vancomycin led to a 3-fold increased risk of subsequent CIED infections. Given that a majority of implanters in our study prefer to prescribe multi-day courses of antibiotics despite such conflicting data highlights, the need for stricter adherence to practice guidelines regarding this subject.…”

Section: Discussionmentioning

confidence: 99%

A Survey of Antibiotic Use During Insertion of Cardiovascular Implantable Devices Among United States Implanters

et al. 2022

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Antibiotic use for cardiovascular implantable devices (CIED) prophylaxis is well-accepted despite a paucity of data. Pre-procedural prophylaxis lowers the rate of CIED infections; however, data is lacking for intra- or post-procedural antibiotic use. Antibiotic-eluting envelopes (ENVELOPE) [TYRX®TM] have been shown to reduce post-procedural infections. Understanding implanter practices may provide insight as to the need for antibiotic stewardship. The purpose of this survey was to assess the practices of implanters nationally. A survey was completed by 150 implanters across the US. Participants were board certificated, implanters of CIEDs, with varying experience (1–25 years), in various hospital settings. Of the respondents, 97% reported routine use of systemic antibiotics pre-operatively. About two-thirds of implanters continue systemic antibiotics post-operatively, with half continuing antibiotics for >24 h; 83% of implanters add antibiotic to saline for the purpose of irrigating the wound; 55% routinely use ENVELOPE on approximately 38% of patients. Common reasons cited for ENVELOPE use were infection concerns, significant risk factors, prior device infection, and immunosuppressed status. Two-thirds of respondents use systemic antibiotics during generator changes, with >50% continuing antibiotics for >24 h. This study suggests wide variations in practice among implanters. Additional attention to existing guidelines and evidence regarding appropriate use of ENVELOPE is still needed.

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Section: Discussionmentioning

confidence: 99%

A Survey of Antibiotic Use During Insertion of Cardiovascular Implantable Devices Among United States Implanters

et al. 2022

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“…In such contexts the first choice is vancomycin, which also acts on methicillin‐resistant and coagulase‐negative bacteria; it is more expensive and must be administered 1½–2 h prior to skin incision. As correctly reported by Alzahrani et al., 19 vancomycin is often overprescribed, and administration time is different than cefazolin (90–120 min vs. 60 min before surgery) and often not well considered. Therefore, this could cause the development of antibiotic resistance, facilitating new infections and reducing the effectiveness of vancomycin.…”

Section: Checklists In the Healthcarementioning

confidence: 98%

Preoperative checklist to reduce the risk of cardiac implantable electronic device infections

Ziacchi

Massaro

Angeletti

et al. 2022

Pacing Clinical Electrophis

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Cardiac implantable electronic device (CIED) infection represents a dramatic event with a high mortality rate (>3x) despite antibiotic therapy and device extraction; therefore, the real winning strategy in this situation could be represented by prevention. Antibiotic prophylaxis and antibiotic‐releasing envelope are effective in improving patient outcome; however, healthcare costs related to CIED infections remain high over the years. In this review we would keep the attention on a pre‐surgical checklist to reduce the risk of CIED infections. In fact, checklist is an effective instrument for medical care quality improvement mainly used in surgery, but not very commonly in cath‐lab and electrophysiology procedures. All steps of this checklist are of proven effectiveness in reducing the risk of CIED infections but, up till now, they are not considered together in a pre‐surgical approach.

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“…Preventing CIEDI? Preprocedural vancomycin has not been shown to improve infectious outcomes compared with that with cefazolin 3,20,21 ; and decisions regarding the use of vancomycin are based on its potential to promote antimicrobial resistance and actually increase the rate of methicillinsusceptible S aureus infections. 20,22 Are There Other Procedural Strategies to Prevent CIEDI?…”

Section: Is Preoperative Prophylaxis With Vancomycin As Effective As ...mentioning

confidence: 99%

Update on Cardiovascular Implantable Electronic Device Infections and Their Prevention, Diagnosis, and Management: A Scientific Statement From the American Heart Association

Baddour,

Esquer Garrigos,

Rizwan Sohail

et al. 2024

Circulation

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The American Heart Association sponsored the first iteration of a scientific statement that addressed all aspects of cardiovascular implantable electronic device infection in 2010. Major advances in the prevention, diagnosis, and management of these infections have occurred since then, necessitating a scientific statement update. An 11-member writing group was identified and included recognized experts in cardiology and infectious diseases, with a career focus on cardiovascular infections. The group initially met in October 2022 to develop a scientific statement that was drafted with front-line clinicians in mind and focused on providing updated clinical information to enhance outcomes of patients with cardiovascular implantable electronic device infection. The current scientific statement highlights recent advances in prevention, diagnosis, and management, and how they may be incorporated in the complex care of patients with cardiovascular implantable electronic device infection.

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Preoperative antibiotics and cardiovascular implantable electronic device infection: A cohort study in veterans

Abstract: Our study revealed that among patients who received surgical site infection prophylaxis for CIED placement or revision, there was: (1) an unanticipated high rate of vancomycin use, and (2) a threefold increase in the incidence of subsequent CIEDI among vancomycin recipient.

Cited by 5 publications

References 40 publications

A Survey of Antibiotic Use During Insertion of Cardiovascular Implantable Devices Among United States Implanters

A Survey of Antibiotic Use During Insertion of Cardiovascular Implantable Devices Among United States Implanters

Preoperative checklist to reduce the risk of cardiac implantable electronic device infections

Update on Cardiovascular Implantable Electronic Device Infections and Their Prevention, Diagnosis, and Management: A Scientific Statement From the American Heart Association

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