Postoperative Antibiotic Prophylaxis Following Cardiac Implantable Electronic Device Placement.

Autor:	Kabulski GM; Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC, USA.; College of Pharmacy, Medical University of South Carolina, Charleston, SC, USA., Northup A; Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA., Wiggins BS; Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC, USA.; College of Pharmacy, Medical University of South Carolina, Charleston, SC, USA.
Jazyk:	angličtina
Zdroj:	The Journal of innovations in cardiac rhythm management [J Innov Card Rhythm Manag] 2019 Aug 15; Vol. 10 (8), pp. 3777-3784. Date of Electronic Publication: 2019 Aug 15 (Print Publication: 2019).
DOI:	10.19102/icrm.2019.100804
Abstrakt:	Infections related to cardiac implantable electronic device (CIED) placement are associated with poor clinical outcomes. As such, preprocedural prophylactic antibiotic therapy is indicated for all patients prior to device insertion. However, the available data are less clear on the impact of postprocedural antibiotic therapy on rates of CIED infection when used in addition to preprocedural therapy. This is single-center, retrospective cohort study of 913 patients who underwent CIED-related procedures between October 2010 and August 2014 sought to compare the rate of CIED infections in patients receiving only preprocedural antibiotics with those receiving both preprocedural and postprocedural antibiotics. Univariate analysis was used to detect independent risk factors for CIED infection. After excluding patients receiving concomitant antibiotics for other conditions, those undergoing CIED extraction alone, and those with a lack of follow-up data and/or adequate documentation of clinical encounters, 569 patients were identified for inclusion in the final analysis. The majority of patients who received postprocedural antibiotics received three to five days of therapy, with the most common antibiotic used being cephalexin. There was no statistically significant difference in the incidence of infection between patients who did and did not receive postoperative antibiotics (4.5% versus 6.1%; p = 0.398). In a multivariate analysis, the use of postprocedural antibiotic therapy was not a significant risk factor for infection (adjusted odds ratio: 0.692; 95% confidence interval: 0.314-1.525; p = 0.361). It is therefore reasonable to withhold prescribing postoperative antibiotics in patients following CIED implantation. Individualized risk factor evaluation of patient comorbidities and procedural characteristics may be needed to aid in determining whether postoperative antibiotics are reasonable in different patients. The validity of these findings is contingent on further confirmation via a prospective, randomized clinical trial. Competing Interests: The authors report no conflicts of interest for the published content. This study was performed in accordance with the Declaration of Helsinki. This human study was approved by Medical University of South Carolina Institutional Review Board. Adult participant consent was not required because the study was a retrospective chart review that involved negligible risk of diversion of protected health information. (Copyright: © 2019 Innovations in Cardiac Rhythm Management.)
Databáze:	MEDLINE
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