Impact of Choice of Prophylaxis on the Microbiology of Cardiac Implantable Electronic Device Infections: Insights From the Prevention of Arrhythmia Device Infection Trial (PADIT).

Autor: Longtin Y; Jewish General Hospital Sir Mortimer B. Davis, McGill University, Montreal, Quebec, Canada.; Lady Davis Research Institute, Montreal, Quebec, Canada., Gervais P; Institut universitaire de cardiologie et de pneumologie de Québec, Laval University, Quebec City, Quebec, Canada., Birnie DH; University of Ottawa Heart Institute, Ottawa, Ontario, Canada., Wang J; Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada., Alings M; Amphia Ziekenhuis & Working Group on Cardiovascular Research (WCN), Breda, the Netherlands., Philippon F; Institut universitaire de cardiologie et de pneumologie de Québec, Laval University, Quebec City, Quebec, Canada., Parkash R; Queen Elizabeth II Health Science Center, Halifax, Nova Scotia, Canada., Manlucu J; Lawson Health Research Institute, London Health Sciences, Western University, London, Ontario, Canada., Angaran P; Department of Medicine, University of Toronto, Division of Cardiology, St. Michael's Hospital, Toronto, Ontario, Canada., Rinne C; St. Mary's General Hospital, Kitchener, Ontario, Canada., Coutu B; Centre hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada., Low RA; Chinook Regional Hospital, Lethbridge, Alberta, Canada., Essebag V; McGill University Health Center, Montreal, Quebec, Canada., Morillo C; Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada., Redfearn D; Kingston General Hospital, Queen's University, Kingston, Ontario, Canada., Toal S; Horizon Health Network, Saint John, New Brunswick, Canada., Becker G; Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, Quebec, Canada., Degrâce M; Hôtel-Dieu de Lévis, Lévis, Quebec, Canada., Thibault B; Montreal Heart Institute, Montreal, Quebec, Canada., Crystal E; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada., Tung S; St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada., LeMaitre J; Royal Columbian Hospital, New Westminster, British Columbia, Canada., Sultan O; Regina General Hospital, Saskatchewan Health Authority, Regina, Saskatchewan, Canada., Bennett M; University of British Columbia, Vancouver, British Columbia, Canada., Bashir J; St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada., Ayala-Paredes F; Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, Quebec, Canada., Rioux L; Centre de santé et de services sociaux de Rimouski-Neigette (CSSSRN), Rimouski, Quebec, Canada., Hemels MEW; Ziekenhuis Rijnstate, Arnhem, and Radboud University Medical Centre, Nijmegen, the Netherlands., Bouwels LHR; Canisius Wilhelmina Ziekenhuis, Nijmegen, the Netherlands., Exner DV; Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada., Dorian P; Department of Medicine, University of Toronto, Division of Cardiology, St. Michael Hospital, Toronto, Ontario, Canada., Connolly SJ; Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada., Krahn AD; University of British Columbia, Vancouver, British Columbia, Canada.
Jazyk: angličtina
Zdroj: Open forum infectious diseases [Open Forum Infect Dis] 2021 Oct 14; Vol. 8 (11), pp. ofab513. Date of Electronic Publication: 2021 Oct 14 (Print Publication: 2021).
DOI: 10.1093/ofid/ofab513
Abstrakt: Background: The Prevention of Arrhythmia Device Infection Trial (PADIT) investigated whether intensification of perioperative prophylaxis could prevent cardiac implantable electronic device (CIED) infections. Compared with a single dose of cefazolin, the perioperative administration of cefazolin, vancomycin, bacitracin, and cephalexin did not significantly decrease the risk of infection. Our objective was to compare the microbiology of infections between study arms in PADIT.
Methods: This was a post hoc analysis. Differences between study arms in the microbiology of infections were assessed at the level of individual patients and at the level of microorganisms using the Fisher exact test.
Results: Overall, 209 microorganisms were reported from 177 patients. The most common microorganisms were coagulase-negative staphylococci (CoNS; 82/209 [39.2%]) and S. aureus (75/209 [35.9%]). There was a significantly lower proportion of CoNS in the incremental arm compared with the standard arm (30.1% vs 46.6%; P  = .04). However, there was no significant difference between study arms in the frequency of recovery of other microorganisms. In terms of antimicrobial susceptibility, 26.5% of microorganisms were resistant to cefazolin. CoNS were more likely to be cefazolin-resistant in the incremental arm (52.2% vs 26.8%, respectively; P  = .05). However, there was no difference between study arms in terms of infections in which the main pathogen was sensitive to cefazolin (77.8% vs 64.3%; P  = .10) or vancomycin (90.8% vs 90.2%; P  = .90).
Conclusions: Intensification of the prophylaxis led to significant changes in the microbiology of infections, despite the absence of a decrease in the overall risk of infections. These findings provide important insight on the physiopathology of CIED infections.
Trial Registration: NCT01002911.
(© The Author(s) 2021. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)
Databáze: MEDLINE
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