A Multicenter Evaluation of Cardiovascular Implantable Electronic Device (CIED) Infection Management. (4th October 2017)

• Record Type: Journal Article
• Authors: Foral, Pamela; Saunders, Jeremiah; Davis, Estella; Packard, Katie; Duggins, Katie; Hrdy, Michaela; Horne, John; Destache, Christopher
• Is Part Of: Open forum infectious diseases. Volume 4(2017)Supplement 1
• Page Start: S558
• Page End: S558
• Publication Date: 2017-10-04
• Subjects: Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofx163.1454
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: The 2010 American Heart Association (AHA) Updated CIED guidelines are standard of care for CIED infections. However, there is a lack of literature evaluating antibiotic (abx) use in CIED infections (CIEDI). We evaluated abx treatment in CIEDI and level of adherence to the AHA guidelines. Methods: A multicenter, retrospective cohort study was conducted from January 1, 2011 to December 31, 2014 in Omaha and Lincoln, NE cardiac patients. Patients > 18 years of age with a CIEDI were included. The following was assessed: abx therapy and duration, CIED as extracted or retained, TEE results, and timing of new CIED implantation. SPSS-PC (ver. 24, Chicago, IL) was used for statistical analysis. Results are reported as mean ± SD or percentage. Results: A total of 86 patients fit inclusion criteria for this review. Mean (±SD) age was 72 ± 11.8 years, with 83% males. The device was extracted in 79% of patients. The most common types of CIEDI were: pocket site (80%), blood stream (26.7%), endocarditis (24%), or lead/generator site (14%). Fifty-four (63%) patients had positive blood cultures. The most common organism isolated was Staphylococcus aureus (23%). In these S. aureus positive patients, 30% did not receive the narrowest spectrum therapy. Abx therapy was significantly longer in the CIED extracted group compared with the retained group (27.8 ± 16.1 days vs. 16.6 ± 13.9 days, P = 0.009). Abx treatment length in 39% of CIEDI was not based on AHA guidelines for appropriate duration. Length of hospitalization was significantly longer for extracted compared with retained CIED (extracted 9 ± 5.8 vs. retained 5.3 ± 4.7 days, P = 0.015). A TEE was completed in approximately half of patients. A new CIED was implanted in 43% of patients. In these new CIED implanted patients, 43% met AHA guidelines regarding timing of implantation and first negative blood culture. In patients with a retained CIED, 2/18 received appropriate abx suppressive therapy. Conclusion: There are multiple opportunities for improvement in regards to AHA guideline-adherent management of CIED-I. Areas of improvement include: removal of infected CIED, appropriate indication-based duration of treatment, and utilizing suppressive abx therapy if the infected CIED is retained. Disclosures: All authors: No reported disclosures.