A Survey of Antibiotic Use During Insertion of Cardiovascular Implantable Devices Among United States Implanters. (April 2023)

• Record Type: Journal Article
• Authors: Kranick, Stephen; Mishra, Nikita; Theertham, Arjun; Vo, Hung; Hiltner, Emily; Coromilas, James; Kassotis, John
• Is Part Of: Angiology. Volume 74:Number 4(2023)
• Page Start: 351
• Page End: 356
• Publication Date: 2023-04
• Subjects: cardiovascular implantable devices infection -- envelope -- antibiotic -- prophylaxis -- envelopes -- survey -- generator exchange; Blood-vessels -- Diseases -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; 616.13005
• DOI: 10.1177/00033197221114689
• Languages: English
• ISSNs: 0003-3197

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.