1110. Temporal trends in duration of antimicrobial therapy and length of hospital stay in cardiovascular implantable electronic device infections
Session: Poster Abstract Session: Infections of Cardiovascular Devices
Saturday, October 22, 2011
Room: Poster Hall B1
Handouts
  • 1110_AssefaAyalew(3).pdf (1.1 MB)
  • Background: With improvements in cardiovascular implantable electronic device (CIED) extraction techniques and incremental knowledge regarding optimal management of CIED infections, shortening of length of hospital stay (LOS) and antimicrobial therapy is expected. In current investigation, we analyzed trends in durations of hospital LOS and antimicrobial therapy for different CIED infection syndromes.

    Methods: We retrospectively reviewed all cases of CIED infection admitted to Mayo Clinic Rochester from 1991 to 2010. Patients were divided into two groups; generator pocket infections and endovascular infections, which included CIED related bacteremia and endocarditis. We compared our institutional practice before and after publication of Mayo Clinic CIED infection management guidelines in 2007 using Students t-test.

    Results: We identified 465 patients from our institutional database. The mean hospital LOS for pocket infections before and after availability of the guidelines was 12.5 days and 15 days, respectively (p value=0.86).  The mean duration of antimicrobial therapy for pocket infections, pre- and post- guidelines, was 20.3 and 18.1 days, respectively (p value= 0.15). There was no statistically significant change in mean time to reimplantation of a replacement device, 25 days and 32.5 days before and after guidelines, respectively (p value=0.62). 

    For endovascular infections, the mean hospital LOS before and after the guidelines was 22.7 and 20.7 days, respectively (p value = 0.22). Average duration of antimicrobial therapy was 34.4 days before and 32.9 days after the guidelines (p value = 0.33) and mean time to implantation of new device was 19.6 days before and 14.1 days after the guidelines publication (p value = 0.18). 

    Conclusion: Despite advances in our understanding of CIED infection and availability of standarized institutional CIED management guidelines, duration of hospital LOS and antimicrobial therapy did not change as expected.  Novel patient management interventions are needed to improve compliance with published institutional guidelines.


    Subject Category: J. Clinical practice issues

    Assefa Ayalew1, Katherine Y. Le, MD, MPH2, Larry M. Baddour, MD2, Paul A. Friedman, MD2, David Hayes, MD3, Raymund Razonable, MD4, Walter R. Wilson, MD2, James Steckelberg, MD, FIDSA5 and Muhammad R. Sohail, MD2, (1)Mayo Medical School , Rochester , MN, (2)Mayo School of Graduate Medical Education, Rochester, MN, (3)Mayo Clinic College of Medicine, Rochester, MN, (4)Mayo Clinic, Rochester, MN, (5)Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Rochester, MN

    Disclosures:

    A. Ayalew, IDSA: Medical scholars grant recipient , <$10000 and Grant recipient

    K. Y. Le, None

    L. M. Baddour, Up ToDate Inc: Royality payment , Licensing agreement or royalty and Royality payments (<$10000)
    Massachusetts Medical Society (Journal Watch Infectious Diseases): Consultant and Editorship , Editorship <$20000

    P. A. Friedman, Medtronic, Guidant, Astra Zeneca: Consultant and Honoraria/Consultant, <$10000
    Medtronic, Astra Zeneca via Beth Israel, Guidant, St. Jude, Bard: Sponsored reseracch, <$10000
    Bard EP, Hewlett Packard, Medical Positioning, Inc.: Intellectual property rights , <$10000

    D. Hayes, Medtronic, Boston Scientific, St. Jude Medical, Sorin Medical, Biotronik: Honoraria, <$10000
    Boston Scientific, St. Jude Medical, Medtronic: Scientific Advisor, <$10000
    Medtronic, St. Jude Medical: Steering Committee, <$10000

    R. Razonable, None

    W. R. Wilson, None

    J. Steckelberg, None

    M. R. Sohail, TyRx Pharma, Inc: Honoraria/Consultant, <$10000

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.