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

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]...

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Bibliographic Details
Published in:Angiology 2023-04, Vol.74 (4), p.351-356
Main Authors: Kranick, Stephen, Mishra, Nikita, Theertham, Arjun, Vo, Hung, Hiltner, Emily, Coromilas, James, Kassotis, John
Format: Article
Language:English
Subjects:
Anti-Bacterial Agents - therapeutic use
Antibiotic Prophylaxis
Defibrillators, Implantable - adverse effects
Humans
Pacemaker, Artificial - adverse effects
Surveys and Questionnaires
United States
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Summary: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.
ISSN:0003-3197
1940-1574
DOI:10.1177/00033197221114689