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Cardiac Electrophysiology Laboratories: A Potential Target for Antimicrobial Stewardship and Quality Improvement?

Published online by Cambridge University Press:  20 June 2016

Westyn Branch-Elliman ,
Maggie Stanislawski ,
Judith Strymish ,
Anna E. Barón ,
Kalpana Gupta ,
Paul D. Varosy ,
Howard S. Gold  and
P. Michael Ho
Westyn Branch-Elliman*
Affiliation:
Eastern Colorado VA Healthcare System, Department of Medicine, Divisions of Infectious Diseases and Cardiology, Denver, Colorado University of Colorado School of Medicine, Department of Medicine, Divisions of Infectious Diseases and Cardiology, Denver, CO Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington, and Denver, Colorado
Maggie Stanislawski
Affiliation:
Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington, and Denver, Colorado
Judith Strymish
Affiliation:
Boston VA Healthcare System, Department of Medicine, Division of Infectious Diseases, West Roxbury, Massachusetts Harvard Medical School, Boston, Massachusetts
Anna E. Barón
Affiliation:
University of Colorado School of Medicine, Department of Medicine, Divisions of Infectious Diseases and Cardiology, Denver, CO Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington, and Denver, Colorado Colorado School of Public Health, Department of Biostatistics and Informatics, Denver, Colorado
Kalpana Gupta
Affiliation:
Boston VA Healthcare System, Department of Medicine, Division of Infectious Diseases, West Roxbury, Massachusetts Boston University School of Medicine, Boston, Massachusetts
Paul D. Varosy
Affiliation:
Eastern Colorado VA Healthcare System, Department of Medicine, Divisions of Infectious Diseases and Cardiology, Denver, Colorado University of Colorado School of Medicine, Department of Medicine, Divisions of Infectious Diseases and Cardiology, Denver, CO Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington, and Denver, Colorado
Howard S. Gold
Affiliation:
Harvard Medical School, Boston, Massachusetts Beth Israel Deaconess Medical Center, Department of Medicine, Division of Infectious Diseases, Boston, Massachusetts
P. Michael Ho
Affiliation:
Eastern Colorado VA Healthcare System, Department of Medicine, Divisions of Infectious Diseases and Cardiology, Denver, Colorado University of Colorado School of Medicine, Department of Medicine, Divisions of Infectious Diseases and Cardiology, Denver, CO Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington, and Denver, Colorado
*
Address correspondence to Westyn Branch-Elliman, MD, MMSc, Boston VA Healthcare System, 1400 VFW Parkway, West Roxbury, MA (Westyn.Branch-Elliman@VA.gov).
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Abstract

BACKGROUND

Infections following cardiovascular implantable electronic device (CIED) procedures, including pacemaker and implantable cardioverter–defibrillators, are devastating and costly. Preimplantation prophylactic antimicrobials are effective for reducing postprocedural infections. However, routine postprocedural antimicrobials are not associated with improved outcomes, and they may be harmful. Thus, we sought to characterize antimicrobial use patterns following CIED procedures.

DESIGN

All patients who underwent CIED procedures from October 1, 2007 to September 30, 2013 and had procedural information entered into the VA Clinical Assessment Reporting and Tracking (CART) software program were included in this study. All antibiotic prescriptions lasting more than 24 hours following device implantation or revision were identified using pharmacy databases, and postprocedural antibiotic use lasting more than 24 hours was characterized.

RESULTS

In total, 3,712 CIED procedures were performed at 34 VA facilities on 3,570 patients with a mean age of 71.7 years (standard deviation [SD], 11.1 years), 98.4% of whom were male. Postprocedural antibiotics >24 hours were prescribed following 1,579 of 3,712 CIED procedures (42.5%). The median duration of therapy was 5 days (interquartile range [IQR], 3–7 days). The most commonly prescribed antibiotic was cephalexin (1,152 of 1,579; 72.9%), followed by doxycycline (118 of 1,579; 7.47%) and ciprofloxacin (93 of 1,579; 5.9%). Vancomycin was used in 73 of 1,579 prescriptions (4.62%). Among the highest quartile of procedural volume, prescribing practices varied considerably, ranging from 3.2% to 77.6%.

CONCLUSIONS

Nearly 1 in 2 patients received prolonged postprocedural antimicrobial therapy following CIED procedures, and the rate of postprocedural antimicrobial therapy use varied considerably by facility. Given the lack of demonstrated benefit of routine prolonged antimicrobial therapy following CIED procedures, antimicrobial use following cardiac device interventions may be a potential target for quality improvement programs and antimicrobial stewardship.

Infect Control Hosp Epidemiol 2016;37:1005–1011

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 9 , September 2016 , pp. 1005 - 1011
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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