201. Cardiac Electrophysiology Laboratories: A Potential Target for Antimicrobial Stewardship?
Session: Poster Abstract Session: Antimicrobial Stewardship: Current State and Future Opportunities
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • ID Week 2015 Cardiac EP labs abx use poster 52603 FINAL PDF.pdf (1.9 MB)
  • 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. 

    Westyn Branch-Elliman, MD, MMSc1,2,3, Maggie Stanislawski, MS3, Judith Strymish, MD4, Howard S. Gold, MD, FIDSA5,6, Kalpana Gupta, MD, MPH7, Preston Schneider, MD, MS8, Anna Baron, PhD3, Paul Varosy, MD3,9 and Michael Ho, MD, PhD10, (1)Medicine, Division of Infectious Diseases, Denver VA Medical Center, Denver, CO, (2)Medicine, University of Colorado, Aurora, CO, (3)Denver VA Center for Outcomes and Innovations (COIN), Denver, CO, (4)Medicine, Harvard Medical School, Boston, MA, (5)Harvard Med. Sch., Boston, MA, (6)Department of Medicine, Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, (7)Department of Medicine/Boston University School of Medicine, Boston, MA, (8)Medicine, Division of Cardiology, University of Colorado, Denver, CO, (9)Medicine, Division of Cardiology, Denver VA Medical Center and University of Colorado, Denver, CO, (10)University of Colorado School of Medicine, Denver, CO

    Disclosures:

    W. Branch-Elliman, None

    M. Stanislawski, None

    J. Strymish, None

    H. S. Gold, None

    K. Gupta, None

    P. Schneider, None

    A. Baron, None

    P. Varosy, None

    M. Ho, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.