2126. Comparative Effectiveness of Infection Prevention Interventions for Reducing Procedure Related Cardiac Device Infections: Insights from the VA CART program
Session: Poster Abstract Session: Healthcare Epidemiology: Surgical Site Infections
Saturday, October 6, 2018
Room: S Poster Hall
Posters
  • CIED Risk Factors Poster ID week FINAL.pdf (379.8 kB)
  • Background:

    Cardiovascular implantable electronic device (CIED) infections are highly morbid, thus peri-procedural prevention interventions are employed to reduce them. However, little data exists evaluating the comparative effectiveness of these prevention interventions. Thus, the objective of this study was to measure the association between infection prevention and antimicrobial prophylaxis strategies and procedure-related CIED infections among a national, multi-center cohort using a nested case-control design.

    Methods:

    A selection of procedures entered into the VA Clinical Assessment Reporting and Tracking-Electrophysiology cohort from FY 2008-16 underwent manual review for presence of infection and for type of prevention strategy used. The primary outcome was 6-month incidence of CIED infection. Measures of association were calculated using multivariable logistic regression.

    Results:

    114 CIED infections among 2,131 procedures were identified; 18 were superficial and 98 were deep. In a multivariable analysis, procedural factors associated with increased odds of procedure-related CIED infections included procedure complications (e.g., hematoma) and revisions (Table 1). Prevention factors associated with reduced risk included chlorhexidine (CHG) skin cleaning, pre-procedure prophylaxis with a beta-lactam, and intra-procedure antibiotic washes. Infection prevention strategies that were not associated with risk reduction included: antibiotic mesh pockets, combination prophylaxis regimens (e.g., beta-lactam plus vancomycin), and prolonged antimicrobial prophylaxis lasting >24 hours post-procedure.

    Conclusion:

    Although the major driver of procedure-related CIED infections are procedural factors and complications, some infection prevention strategies are beneficial. These results should be used to inform infection prevention and antimicrobial stewardship practices in the electrophysiology laboratory.

    Table 1: Factors associated with risk of CIED infection

    Intervention

    Odds Ratio

    (95% CI)

    P-value

    Procedure complication

    4.3 (2.6 – 7.2)

    <0.001

    Revision

    2.0 (1.3 – 3.1)

    0.002

    Pre-procedure CHG

    0.40 (1.3 – 3.1)

    0.002

    Pre-procedure beta-lactam

    0.59 (0.38 – 0.72)

    0.024

    Antibiotic washes

    0.51 (0.27 – 0.99)

    0.045

    Archana Asundi, MDCM1,2, Maggie Stanislawski, PhD3,4, Payal Mehta, MD2 and Westyn Branch-Elliman, MD, MMSc2,5,6, (1)Internal Medicine, Section of Infectious Diseases, Boston University Medical Center, Boston, MA, (2)VA Boston Healthcare System, West Roxbury, MA, (3)Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, (4)University of Colorado School of Public Health, Denver, CO, (5)Harvard Medical School, Boston, MA, (6)Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, West Roxbury, MA

    Disclosures:

    A. Asundi, None

    M. Stanislawski, None

    P. Mehta, None

    W. Branch-Elliman, Veterans' Integrated Service Network Career Development Award: Investigator , Research grant . American Heart Association: Investigator , Research grant .

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.