Incidence of Surgical-Related Infections in Temporary Mechanical Circulatory Support Patients Using Narrow Spectrum versus Broad Spectrum Peri-Operative Antibiotic Prophylaxis

Abstract

Purpose To date, there are no studies evaluating the effects of prophylactic antibiotic regimens in patients receiving temporary Impella® mechanical circulatory support (MCS). The purpose of this study was to compare the incidence of surgical-related infections within 30 days of temporary MCS implantation in patients receiving narrow versus broad spectrum peri-operative antibiotics. Methods 89 Patients receiving Impella® 5, 5.5, and CP devices in a surgical setting at Cedars-Sinai Medical Center from January 2017 to August 2020 were included for analysis which was IRB approved. This study period includes devices implanted before and after the implementation of MCS Antibiotic Selection for Surgical Prophylaxis Guideline. This protocol recommends cefazolin or ceftriaxone for pre-op surgical prophylaxis, with gentamicin for additional gram-negative coverage and vancomycin for beta-lactam allergy. 34/89 (38.2%) patients were identified as Stewardship (protocol adherence), while 27/89 (30.3%) were identified as Conventional (protocol non-adherence) another 28/89 (31.5%) patients were identified as Pre-existing (admitted with prior antimicrobial). The primary endpoint was the incidence of surgical site infections (SSI) and surgical-related bacteremia (SRB) within 30-day post-implant period. The secondary endpoint was protocol adherence. Results 72%, 26% and 2% of patients were bridged to heart transplant, durable MCS or no device, at 30 days respectively. There were no cases of SSI within 30 days post-operatively in any group, except for one case of SRB with Streptococcus mitis bacteremia in the Conventional group. Patients were screened for Methicillin-resistant Staphylococcus aureus (MRSA) colonization before incision in 72.2% of cases (mean, 2.6 days prior to device implantation). Reasons for non-adherence included incorrect duration of post-operative antibiotic(s) (44.4%), no pre-operative antibiotic given prior to incision (25.9%), and incorrect pre-operative antibiotic(s) given (22.2%). Conclusion The absence of SSI and SRB among Stewardship group supports narrow spectrum pre-op antibiotic prophylaxis over broad-spectrum agents for Impella® non-durable MCS.