Vancomycin Prophylaxis (VAN PPx) for Intra-aortic Balloon Pump (IABP)

Abstract

Vancomycin (VAN) has been used in some facilities to prevent intra-aortic balloon pump (IABP)-related infections. However, the data are scarce. Emergence of drug resistant organisms, costs and side effects of VAN are significant concerns. The use of VAN prophylaxis (PPx) for IABP was decided by the admitting physicians in our facility. A retrospective observational study of adults with an IABP at Memorial Hermann Hospital from 07/2012 until 3/2016 was conducted. Patients were excluded if they were treated with other antibiotics for more than 24 hours after the insertion or if they were less than 18 years old. All demographic data, clinical information, and the durations of VAN PPx and IABP were analyzed. Outcomes evaluated were all-cause mortality, fever, positive blood cultures, IABP site infections and IABP exchange. A total of 352 patients was identified; 154 patients were excluded due to concomitant use of antibiotic therapy (n = 135) and due to age <18 years old (N = 19). 198 patients were eligible; 55 (28 %) received VAN PPx and 143 (72 %) did not receive VAN. APACHE II score was significantly higher in VAN PPx group compared with non-PPx group (12 and 10, respectively P = 0.01). Non-VAN PPx group had more ST segment elevation myocardial infarction as the indication of IABP than VAN PPx group (50% vs. 16%, P = 0.01). Otherwise, no significant differences in the baseline characteristics were seen among the groups. All evaluated outcomes were NOT significantly different between VAN PPx and non-PPx groups. An event free Kaplan Meier (KM) curve was not different between the groups (Log Rank P = 0.514) (Figure 1). After propensity score matching with APACHE II score, no difference of outcomes were seen. 24 % of patients in PPx group had inadequate VAN trough levels (less than 10 mcg/mL). The rates of multi-resistant organisms or Clostridium difficile related infections were not significantly different between the groups. VAN PPx did not change patient outcomes nor prevent IABP infections. Frequent inadequate VAN levels were observed in VAN PPx group. Further larger studies are warranted to confirm the findings. Event free KM curve All authors: No reported disclosures.