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

Abstract

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.

Physician antibiotic hydration preferences for biologic antibacterial envelopes during cardiac implantable device procedures

“…Finally, we looked closely at preoperative antibiotic prophylaxis compliance (which similar to the WRAP-IT trial was not controlled in our study) in conjunction with envelope usage, which revealed diverse and some concerning practice patterns. This finding is also corroborated by a recent independent survey of implanting physicians in the USA, which is further described below ( 39 ).…”

“…Our findings are similar to recently published results from an independent survey of antibiotic use during CIED implantation in the United States. Although the survey respondents reported a 97% rate of routine use of pre-operative systemic antibiotics (similar to our 96.6% overall compliance rate), the authors also found that there were wide variations in implanter practices ( 39 ).…”