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Almonte M, Huston T, Yee SL, Karimaei R, Hort A, Rawlins M, Seet J, Nizich Z, McLellan D, Stobie P, Czarniak P, Chalmers L. Adherence to antimicrobial prophylaxis guidelines in cardiac implantable electronic device procedures in two Australian teaching hospitals. AUST HEALTH REV 2021; 45:761-770. [PMID: 34470697 DOI: 10.1071/ah21046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/25/2021] [Indexed: 11/23/2022]
Abstract
Objective This study investigated antibiotic prophylaxis (AP) guideline adherence and the cardiac implantable electronic device (CIED) infection rate in two major Australian public teaching hospitals. Methods In a retrospective observational study, the medical records of patients who underwent CIED procedures between January and December 2017 were reviewed (Hospital A, n = 400 procedures; Hospital B, n = 198 procedures). Adherence to AP guidelines was assessed regarding drug, dose, timing, route and frequency. Infection was identified using follow-up documentation. Results AP was administered in 582 of 598 procedures (97.3%). Full guideline adherence was observed in 33.9% of procedures (203/598) and differed significantly between Hospitals A and B (47.3% vs 7.1%, respectively; P < 0.001). Common reasons for non-adherence were the timing of administration (42.3% vs 60.6% non-adherent in Hospitals A and B, respectively; P < 0.001) and repeat dosing (19.3% vs 78.8% non-adherent in Hospitals A and B, respectively; P < 0.001). Twenty infections were identified over 626.6 patient-years of follow-up (mean (±s.d.) follow-up 1.0 ± 0.3 years). The infection rate was 3.19 per 100 patient-years (P = 0.99 between hospitals). Two devices were removed due to infection; no patients died from CIED infection. Conclusions Although the rate of serious CIED infection was low, there was evidence of highly variable and suboptimal antibiotic use, and potential overuse of AP. What is known about the topic? Previous Australian studies have revealed high rates of inappropriate surgical AP. CIED infections are potentially life threatening, but can be avoided through effective use of AP. However, prolonged durations of AP in this setting may also result in complications, including Clostridioides difficile infection. What does this paper add? This study, the first to our knowledge to focus specifically on adherence to Australian guidelines for AP in CIED procedures, highlighted several common issues between AP in this setting and surgical and procedural AP more broadly. 'Early' and 'late' dose administration and extended post-procedural AP were common. Only 34% of prescriptions fully adhered to the guidelines; practices varied significantly between the two hospitals. What are the implications for practitioners? There is a clear need for institution-specific antimicrobial stewardship strategies to optimise AP in CIED procedures, aligned with the Antimicrobial Stewardship Clinical Care Standard. Patients are being placed at potentially avoidable risk of both complications of extended durations of AP and CIED infection, although the rate of serious CIED infection was low. A standardised approach to surveillance of CIED infections and prospective multisite audits of AP in CIED procedures using a validated tool, such as the Surgical National Antimicrobial Prescribing Survey, are recommended to better inform evidence-based practice. Potential strategies to optimise guideline adherence include prescribing support in patients with immediate penicillin hypersensitivity or methicillin-resistant Staphylococcus aureus colonisation, optimising the in-patient location of drug administration to promote timely dosing, limiting inappropriate post-procedural prophylaxis and routine S. aureus screening and decolonisation.
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Affiliation(s)
- Monique Almonte
- School of Pharmacy and Biomedical Sciences, Curtin University, Bentley, WA, Australia. ; ; ; ; and Present address: Northlands Pharmacy, Balcatta, WA, Australia
| | - Taylor Huston
- School of Pharmacy and Biomedical Sciences, Curtin University, Bentley, WA, Australia. ; ; ; ; and Present address: TerryWhite Chemmart Leeming, Leeming, WA, Australia
| | - Sok Ling Yee
- School of Pharmacy and Biomedical Sciences, Curtin University, Bentley, WA, Australia. ; ; ; ; and Present address: Pharmacy Alliance, Albany, WA, Australia
| | - Roya Karimaei
- School of Pharmacy and Biomedical Sciences, Curtin University, Bentley, WA, Australia. ; ; ; ; and Present address: Pharmacy 777 Lynwood, Lynwood, WA, Australia
| | - Adam Hort
- Pharmacy Department, Fiona Stanley Hospital, South Metropolitan Health Service, Murdoch, WA, Australia. ;
| | - Matthew Rawlins
- Pharmacy Department, Fiona Stanley Hospital, South Metropolitan Health Service, Murdoch, WA, Australia. ;
| | - Jason Seet
- Pharmacy Department, Sir Charles Gairdner Hospital, North Metropolitan Health Service, Nedlands, WA, Australia. ;
| | - Zachiah Nizich
- Pharmacy Department, Sir Charles Gairdner Hospital, North Metropolitan Health Service, Nedlands, WA, Australia. ;
| | - Duncan McLellan
- Infectious Diseases Department, Fiona Stanley Hospital, South Metropolitan Health Service, Murdoch, WA, Australia.
| | - Paul Stobie
- Department of Cardiovascular Medicine, North Metropolitan Health Service, Nedlands, WA, Australia.
| | - Petra Czarniak
- School of Pharmacy and Biomedical Sciences, Curtin University, Bentley, WA, Australia. ; ; ; ; and Present address: Curtin Medical School, Curtin University, Bentley, WA, Australia.
| | - Leanne Chalmers
- School of Pharmacy and Biomedical Sciences, Curtin University, Bentley, WA, Australia. ; ; ; ; and Present address: Curtin Medical School, Curtin University, Bentley, WA, Australia. ; and Corresponding author.
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Orjuela A, Cardozo LP. Comparación de dos protocolos de antibiótico profiláctico en implantes de dispositivos de estimulación cardíaca. “COMPROFILAXIA”. REVISTA COLOMBIANA DE CARDIOLOGÍA 2020. [DOI: 10.1016/j.rccar.2019.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Rattanawong P, Kewcharoen J, Mekraksakit P, Mekritthikrai R, Prasitlumkum N, Vutthikraivit W, Putthapiban P, Dworkin J. Device infections in implantable cardioverter defibrillators versus permanent pacemakers: A systematic review and meta-analysis. J Cardiovasc Electrophysiol 2019; 30:1053-1065. [PMID: 30938929 DOI: 10.1111/jce.13932] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/14/2019] [Accepted: 03/22/2019] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Recent studies suggest that implantable cardioverter defibrillators (ICDs) are associated with increased risk of cardiac implantable electronic device (CIED) infections when compared with permanent pacemakers (PPMs). However, there were controversies among studies. In this study we performed a systematic review and meta-analysis to explore the risk of device infection in ICD versus PPM. METHODS We searched the databases of MEDLINE and EMBASE from inception to January 2019. Data from each study were combined using the random-effects, generic inverse variance method of Der Simonian and Laird to calculate odds ratios (OR) and 95% confidence intervals (CI). RESULTS Twenty-seven studies involving 202 323 CIEDs (36 782 ICDs and 165 541 PPMs) were included. Infections occurred from 9 days to 6 years postoperatively. When compared with PPM, ICD had a significantly higher risk of device infection in overall analysis (OR = 1.62, 95% CI: 1.29-2.04). The risk was seen in subgroups such as single chamber or dual chamber device (OR = 1.57, 95% CI: 1.18-2.09), de novo implantation (OR = 1.62, 95% CI: 1.29-2.69), revision implantation (OR = 1.63, 95% CI: 1.24-2.13), and cardiac resynchronization therapy (CRT) (OR = 1.75, 95% CI: 1.18-2.60). CRT-defibrillator increased risk of infection over CRT-pacemaker in revision implantation (OR = 1.81, 95% CI: 1.20-2.74) but not in de novo implantation (OR = 1.07, 95% CI: 0.23-4.88). The increased risk of infection among defibrillator was higher in CRT compared to non-CRT but not significant (P = 0.654). CONCLUSIONS Our meta-analysis demonstrates a statistically significant increased risk of device infection in CIED patients who received ICD when compared to PPM.
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Affiliation(s)
- Pattara Rattanawong
- Department of Internal Medicine, University of Hawaii Internal Medicine Residency Program, Honolulu, Hawaii.,Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Jakrin Kewcharoen
- Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Raktham Mekritthikrai
- Department of Internal Medicine, University of Hawaii Internal Medicine Residency Program, Honolulu, Hawaii
| | - Narut Prasitlumkum
- Department of Internal Medicine, University of Hawaii Internal Medicine Residency Program, Honolulu, Hawaii
| | - Wasawat Vutthikraivit
- Department of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | | | - Jonathan Dworkin
- Department of Internal Medicine, University of Hawaii, Honolulu, Hawaii
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Henrikson CA, Sohail MR, Acosta H, Johnson EE, Rosenthal L, Pachulski R, Dan D, Paladino W, Khairallah FS, Gleed K, Hanna I, Cheng A, Lexcen DR, Simons GR. Antibacterial Envelope Is Associated With Low Infection Rates After Implantable Cardioverter-Defibrillator and Cardiac Resynchronization Therapy Device Replacement: Results of the Citadel and Centurion Studies. JACC Clin Electrophysiol 2017; 3:1158-1167. [PMID: 29759500 DOI: 10.1016/j.jacep.2017.02.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 02/14/2017] [Accepted: 02/24/2017] [Indexed: 01/27/2023]
Abstract
OBJECTIVES This study sought to determine whether the nonabsorbable TYRX Antibacterial Envelope (TYRX) reduces major cardiovascular implantable electronic device (CIED) infections 12 months after implant. BACKGROUND TYRX is a monofilament polypropylene mesh impregnated with minocycline and rifampin specifically designed to hold a CIED in place and elute antimicrobials over time. There are limited data on its ability to reduce CIED infections. METHODS We prospectively enrolled patients who underwent generator replacement with an implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy device (CRT), treated with TYRX. The primary endpoints were major CIED infection and CIED mechanical complications. Given the differences in infection rates among ICD and CRT patients, 3 different control populations were used: a published benchmark rate for ICD patients, and both site-matched and comorbidity-matched controls groups for CRT patients. RESULTS Overall, a major CIED infection occurred in 5 of 1,129 patients treated with TYRX (0.4%; 95% confidence interval: 0.0% to 0.9%), significantly lower than the 12-month benchmark rate of 2.2% (p = 0.0023). Among the TYRX-treated CRT cohort, the major CIED infection rate was 0.7% compared with an infection rate of 1.0% and 1.3% (p = 0.38 and p = 0.02) in site-matched and comorbidity-matched control groups, respectively. Among the ICD group, the 12-month infection rate was 0.2% compared with the published benchmark of 2.2% (p = 0.0052). The most common CIED mechanical complication in study patients was pocket hematoma, which occurred in 18 of the 1,129 patients (1.6%; 95% confidence interval: 0.8 to 2.5), which is comparable with a published rate of 1.6%. CONCLUSIONS Use of TYRX was associated with a lower major CIED infection rate. (TYRX™ Envelope for Prevention of Infection Following Replacement With a CRT or ICD; [Centurion]; NCT01043861/NCT01043705).
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Affiliation(s)
- Charles A Henrikson
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon.
| | - M Rizwan Sohail
- Divisions of Infectious Diseases and Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota
| | | | | | - Lawrence Rosenthal
- Division of Cardiovascular Medicine, UMass Memorial Medical Center, Worcester, Massachusetts
| | | | - Dan Dan
- Piedmont Medical Center, Atlanta, Georgia
| | | | | | | | - Ibrahim Hanna
- Princeton Baptist Medical Center, Birmingham, Alabama
| | | | | | - Grant R Simons
- Division of Electrophysiology, Englewood Hospital and Medical Center, Englewood, New Jersey
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Implementation of Infection Prevention and Antimicrobial Stewardship in Cardiac Electrophysiology Laboratories: Results from the SHEA Research Network. Infect Control Hosp Epidemiol 2017; 38:496-498. [PMID: 28103958 DOI: 10.1017/ice.2016.309] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Infection prevention in electrophysiology (EP) laboratories is poorly characterized; thus, we conducted a cross-sectional survey using the SHEA Research Network. We found limited uptake of basic interventions, such as surveillance and appropriate peri-procedural antimicrobial use. Further study is needed to identify ways to improve infection prevention in this setting.
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Hooper TD, Hibbert PD, Hannaford NA, Jackson N, Hindmarsh DM, Gordon DL, Coiera EC, Runciman WB. Surgical site infection-a population-based study in Australian adults measuring the compliance with and correct timing of appropriate antibiotic prophylaxis. Anaesth Intensive Care 2015; 43:461-7. [PMID: 26099757 DOI: 10.1177/0310057x1504300407] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Prophylaxis for surgical site infection (SSI) is often at variance with guidelines, despite the prevalence of SSI and its associated cost, morbidity, and mortality. The CareTrack Australia study, undertaken by a number of the authors, demonstrated that appropriate care (in line with evidence- or consensus-based guidelines) was provided at 38% of eligible SSI healthcare encounters. Here, we report the indicator-level CareTrack Australia findings for SSI prophylaxis. Indicators were extracted from Australian and international clinical guidelines and ratified by clinical experts. A sample designed to be representative of the Australian population was recruited (n=1154). Participants' medical records were reviewed and analysed for compliance with the five SSI indicators. The main outcome measure was the percentage of eligible healthcare encounters with documented compliance with indicators for appropriate SSI prophylaxis. Of the 35,145 CareTrack Australia encounters, 702 (2%) were eligible for scoring against the SSI indicators. Where antibiotics were recommended, compliance was 49% for contaminated surgery, 57% for clean-contaminated surgery and 85% for surgery involving a prosthesis: these fell to 8%, 10% and 14%, respectively (an average of 11%), when currently recommended timing of antibiotic administration was included. Where antibiotics were not indicated, 72% of patients still received them. SSI prophylaxis in our sample was poor; over two-thirds of patients were given antibiotics, whether indicated or not, mainly at the wrong time. There is a need for national agreement on clinical standards, indicators and tools to guide, document and monitor SSI prophylaxis, with both local and national measures to increase and monitor their uptake.
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Affiliation(s)
- T D Hooper
- Project Manager, Centre for Sleep Research, University of South Australia, Adelaide, South Australia
| | - P D Hibbert
- Program Manager, Australian Institute of Health Innovation, University of New South Wales, Sydney, New South Wales
| | - N A Hannaford
- Senior Analyst, Clinical Research, Centre for Sleep Research, University of South Australia, Adelaide, South Australia
| | - N Jackson
- Research Assistant, Australian Institute of Health Innovation, University of New South Wales, Sydney, New South Wales
| | - D M Hindmarsh
- Biostatistician, Australian Institute of Health Innovation, University of New South Wales, Sydney, New South Wales
| | - D L Gordon
- Professor, Microbiology and Infectious Diseases, SA Pathology, Flinders Medical Centre, Bedford Park, South Australia
| | - E C Coiera
- Professor, Chief Investigator, Australian Institute of Health Innovation, University of New South Wales, Sydney, New South Wales
| | - W B Runciman
- Chief Investigator, Centre for Sleep Research, University of South Australia, Adelaide, South Australia
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Polyzos KA, Konstantelias AA, Falagas ME. Risk factors for cardiac implantable electronic device infection: a systematic review and meta-analysis. ACTA ACUST UNITED AC 2015; 17:767-77. [DOI: 10.1093/europace/euv053] [Citation(s) in RCA: 281] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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