Analysis of the use of empiric antimicrobial prophylaxis for temporary cardiac devices at a large academic medical center

• Published in: Perfusion 2024-09, Vol.39 (6), p.1197-1204
• Main Authors: Kim, Ju Hee, Mason, Jessica, Toyoda, Alexander Y, Ji, Christine S, Gandhi, Ronak G, Solomon, Edmond J
• Format: Article
• Language: English
• Subjects: Academic Medical Centers; Aged; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - therapeutic use; Antibiotic Prophylaxis - methods; Antibiotics; Aorta; Balloon treatment; Devices; Disease prevention; Extracorporeal membrane oxygenation; Extracorporeal Membrane Oxygenation - adverse effects; Extracorporeal Membrane Oxygenation - methods; Female; Health care facilities; Heart rate; Hospitals; Humans; Impact analysis; Infections; Insertion; Intensive care units; Male; Middle Aged; Oxygenation; Prophylaxis
• ISSN: 0267-6591; 1477-111X; 1477-111X
• DOI: 10.1177/02676591231182249

Introduction Varying rates of access site infections with temporary percutaneous cardiac devices have been reported in the literature. The purpose of this study is to determine the impact of a change in institutional practice in utilizing antimicrobial prophylaxis to prevent access site infections in patients with these devices. Methods This observational, pre-post implementation analysis evaluated the benefit of prophylactic antimicrobial therapy in adult patients with temporary percutaneous cardiac devices admitted to cardiac intensive care units. Patients in the pre-cohort received prophylactic antibiotics for the duration of device insertion. Patients in the post-cohort received a single dose of intravenous antibiotics for veno-arterial extracorporeal membrane oxygenation (VA-ECMO) or Impella® 5.5 device placement, and no antimicrobial prophylaxis for all other devices placed. The primary endpoint was the incidence of definitive access site infection. Secondary endpoints included the incidence of Clostridium difficile infection and initiation of broad-spectrum antibiotics. Results Fifty patients in the pre-cohort and 45 patients in the post-cohort were evaluated. Devices included intra-aortic balloon pumps, VA-ECMO, Impella® CP and Impella® 5.5. The median duration of device insertion was four days. No significant difference in the primary outcome was seen between the two groups. A significant reduction in prophylactic antimicrobial utilization and total days of antimicrobial exposure was observed in the post-implementation cohort. Conclusion Based on the results of our study, the implemented guideline reduces the utilization of antimicrobial prophylaxis in patients with temporary percutaneous cardiac devices and does not result in an increased rate of infections.