Background: Infections following cardiac device implantations, such as pacemakers (PPM) and implantable cardioverter-defibrillators (ICD), are common and costly. Pre-implantation antimicrobial prophylaxis reduces incidence of cardiac device infections. Conversely, routine post-procedural antimicrobial use does not reduce infections, and may be harmful, leading to C. difficle infections, adverse drug reactions, and unnecessary excess medical costs. Despite these negative effects, anecdotal reports suggest that post-implantation antimicrobial prophylaxis is common. Thus, we sought to characterize antimicrobial utilization following cardiac device implantations.
Methods: All patients who received a cardiac device implantation (PPM or ICD) and were entered into the VA Clinical Assessment Reporting and Tracking (CART) database from 10/1/07-9/30/13 were included. The VA CART Program is a clinical quality improvement program within the VA, designed to improve outcomes following cardiac procedures. All antibiotic orders lasting for >24 hours following device implantation were identified using the VA bar coding pharmaceutical database, and post-procedural antibiotic utilization was characterized.
Results: 3,712 device implantations were identified at 34 different VAs. 1211/3712 (32.6%) of implantations were performed on an ambulatory basis. The mean age was 72.0 (SD, 11.1). 98.4% of patients were male. >24 hours of post-procedural antibiotics were prescribed following 1,579/3,712 (42.5%) of implantations. The median duration of therapy was 5 days (IQR, 5-7 days) (Fig 1). The most commonly prescribed antibiotic was cephalexin (1152/1579, 73.0%), followed by doxycycline (118/1579, 7.47%), and ciprofloxacin (101/1579, 6.4%). Vancomycin was used in 73/1579, 4.62%. Other antimicrobials were prescribed infrequently.
Conclusion: Prolonged post-procedural antimicrobial therapy is common following cardiac device implantation, despite evidence demonstrating that this practice is not beneficial and potentially harmful. Antimicrobial use in this setting is a potential target for antimicrobial stewardship programs.
J. Strymish, None
H. S. Gold, None
K. Gupta, None
P. Schneider, None
A. Baron, None
P. Varosy, None
M. Ho, None
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