2126. Comparative Effectiveness of Infection Prevention Interventions for Reducing Procedure-Related Cardiac Device Infections: Insights from the VA CART Program

Abstract

BackgroundCardiovascular 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.MethodsA selection of procedures entered into the VA Clinical Assessment Reporting and Tracking-Electrophysiology cohort from FY 2008–2016 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.ResultsOne hundred and fourteen 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 β-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., β-lactam plus vancomycin), and prolonged antimicrobial prophylaxis lasting >24 hours post-procedure.ConclusionAlthough 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 InfectionInterventionOdds Ratio (95% CI) P-ValueProcedure complication4.3 (2.6–7.2)<0.001Revision2.0 (1.3–3.1)0.002Pre-procedure CHG0.40 (1.3–3.1)0.002Pre-procedure β-lactam0.59 (0.38–0.72)0.024Antibiotic washes0.51 (0.27–0.99)0.045Disclosures W. Branch-Elliman, Veterans’ Integrated Service Network Career Development Award: Investigator, Research grant. American Heart Association: Investigator, Research grant.