1471. International Survey of Knowledge, Attitude, and Practice of Cardiologists Regarding Prevention and Management of Cardiac Implantable Device Infections
Session: Poster Abstract Session: HAI: Surgical Site Infections
Friday, October 28, 2016
Room: Poster Hall
Background: Cardiovascular implantable electronic devices (CIEDs) can improve symptoms and mortality. However, CIED infection can be life-threatening and is usually managed with complete device removal (generator and leads). Despite publication of CIED infection management guidelines, there remains marked variation in clinical practice. To better understand and quantify these differences, we conducted an international survey.

Methods: Following an internally pilot study, an electronic survey was sent to all members of the Heart Rhythm Society, spanning 70 countries. All responses were collected anonymously.

Results: There were a total of 246 responders. The majority of surveys were completed by members from the US (168; 68.3%) and who practiced in academic medical centers (53.8%). While almost all locations (92.7%) had protocols in place to ensure appropriate timing of antimicrobial prophylaxis at the time of implant. The majority (76.1%) do not screen all patients for methicillin-resistant Staphylococcus aureus nasal colonization prior to implantation. Superficial (incisional) site infections were treated with antibiotics in accordance with guidelines only 52.5% of the time. Deep (pocket) infections were treated with antibiotics in accordance with guidelines only 37.4% of the time. Almost all providers (98.7%) noted that complete hardware extraction would be performed with identification of lead vegetation. In contrast, complete CIED removal would be performed in patients with an occult Gram-positive bacteremia (82.2%) and occult Gram-negative bacteremia (65.5%).

Conclusion: Despite overall consistency amongst national guidelines, wide variability exists in clinical practice globally. These findings suggest equipoise and the need for randomized clinical trials to clarify the optimal management strategies of CIED infections.

Daniel C. Desimone, MD1, Anwar Chahal, MB ChB2, Christopher Desimone, MD, PHD3, Samuel Asirvatham, MD2, Paul Friedman, MD2, Larry M. Baddour, MD, FIDSA4 and Muhammad R. Sohail, MD, FIDSA5, (1)Infectious Diseases, Mayo Clinic College of Medicine, Rochester, MN, (2)Mayo Clinic, Rochester, MN, (3)Cardiovascular, Mayo Clinic, College of Medicine, Rochester, MN, (4)Infectious Diseases, Mayo Clinic, Rochester, MN, (5)200 First Street SW, Mayo School of Graduate Medical Education, Rochester, MN

Disclosures:

D. C. Desimone, None

A. Chahal, None

C. Desimone, None

S. Asirvatham, Medtronic: Consultant , Speaker honorarium

P. Friedman, None

L. M. Baddour, None

M. R. Sohail, None

Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.