Impact of Choice of Prophylaxis on the Microbiology of Cardiac Implantable Electronic Device Infections: Insights From the Prevention of Arrhythmia Device Infection Trial (PADIT)
Year: 2021
Type: article
Abstract: 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.
Source: Open Forum Infectious Diseases
DOI: 10.1093/ofid/ofab513
Authors: Yves Longtin, Philippe Gervais, David H Birnie, Jia Wang, Marco Alings, François Philippon, Ratika Parkash, Jaimie Manlucu, Paul Angaran, Claus Rinne, Benoit Coutu, R Aaron Low, Vidal Essebag, Carlos Morillo, Damian Redfearn, Satish Toal, Giuliano Becker, Michel Degrâce, Bernard Thibault, Eugene Crystal, Stanley Tung, John LeMaitre, Omar Sultan, Matthew Bennett, Jamil Bashir, Felix Ayala-Paredes, Leon Rioux, Martin E W Hemels, Leon H R Bouwels, Derek V Exner, Paul Dorian, Stuart J Connolly, Andrew D Krahn
Institutions: Jewish General Hospital, Lady Davis Institute for Medical Research, McGill University, Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, University of Ottawa, Ottawa Heart Institute, Population Health Research Institute, Hamilton Health Sciences, McMaster University, Amphia Ziekenhuis, Queen Elizabeth II Health Sciences Centre, Western University, Lawson Health Research Institute, St. Michael's Hospital, University of Toronto, Centre Hospitalier de l’Université de Montréal, Université de Montréal, Chinook Regional Hospital, McGill University Health Centre, Queen's University, Kingston General Hospital, Horizon Health Network, Hôpital du Sacré-Cœur de Montréal, Hôpital Hôtel-Dieu de Lévis, Montreal Heart Institute, Sunnybrook Health Science Centre, University of British Columbia, St. Paul's Hospital, Royal Columbian Hospital, Saskatchewan Health Authority, Regina General Hospital, Centre Hospitalier Universitaire de Sherbrooke, Radboud University Medical Center, Rijnstate Hospital, Canisius-Wilhelmina Ziekenhuis, University of Calgary, Libin Cardiovascular Institute of Alberta
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,465
Award: G3471069782
OpenAlex ID: W3207489244