Antibiotic Prophylaxis in Cardiac Implantable Electronic Device Procedures: A Tale of Two Western Australian Hospitals

Abstract

Australian guidelines recommend antibiotic prophylaxis (AP) for CIED procedures, however the level of adherence to these guidelines is currently unknown. This study aimed to investigate guideline adherence and the CIED infection rate in the two largest Western Australian public teaching hospitals. In a retrospective, observational study, medical records of patients who underwent CIED procedures at the two hospitals from January to December 2017 were reviewed. Adherence to the AP guidelines was assessed with respect to drug, dose, timing, route and frequency. CIED infection was identified using patient follow-up documentation. AP was administered in 589 (98.5%) of 598 procedures reviewed (Hospital A: n = 400, B: n = 198). Full guideline adherence was observed in 33.9% of procedures and differed significantly between the hospitals (A: 47.3% vs. B: 7.1%, p < 0.001). The most common reasons for non-adherence were timing of administration (A: 42.3% vs. B: 60.6% non-adherent, p < 0.001) and repeat dosing (A: 19.3% vs. B: 78.8% non-adherent, p < 0.001). Twenty infections were identified over 626.6 patient-years (PY) of follow-up (mean [SD] follow-up: 1.0 [0.3] years). The infection rate was 3.19 per 100 PY (p = 0.99 between the two hospitals). Two devices were removed; no patients died from CIED infection. There were no statistically significant associations between infection and any patient, procedure or AP-related factors. Infection occurred in 2.0% of AP guideline adherent and 4.1% of non-adherent cases (p = 0.27). Although the rate of serious infection was low, there was evidence of suboptimal antibiotic use, and notably potential overuse of AP in CIED procedures. Practices varied significantly between hospitals.