Introduction: Infection of cardiac implantable electronic devices (CIEDs) poses considerable risk to patients in terms of morbidity and mortality. The recently published, independently validated Prevention of Arrhythmia Device Infection Trial (PADIT) score predicts infection risk at the time of the device procedure based on non-modifiable risk factors (higher score correlates to greater risk). The risk profile of patients receiving CIED across the North of England Cardiovascular Network (NECVN) is currently unknown. Calculation of the PADIT score potentially allows for tailored, patient-specific consent and modification of antibiotic strategy. In this prospective study, we calculated the PADIT score across implanting centres in the NECVN over a 6-week period and documented peri-procedural antibiotic use.
Methods: Prospective anonymised patient data were collected from across 7 centres in the NECVN and inputted into a shared spreadsheet. We recorded basic baseline demographics, the individual components of the PADIT score and antibiotic strategies, pre-, peri- and postoperatively. Basic statistics were used to evaluate the data.
Results: A total of 271 patients (172 male, 99 female) were involved in this study, with a mean age of 77 years (standard error [SE] 0.8) at non-surgical sites and 71 years (SE 1.2) at surgical sites. The PADIT scores were positively skewed. Subgroup analysis demonstrated significantly higher scores (p<0.05, Kruskal–Wallis test) at the surgical sites (mean 3.3 [SE 0.2], median 3 [range 0–13] compared with mean 1.1 [SE 0.13], median 1 [range 0–8]) due to greater device complexity case mix (implantable defibrillator or cardiac resynchronisation compared with permanent pacemaker). All patients received pre-operative cefuroxime (93/271, 34%) or teicoplanin (178/271, 66%). In addition, 30 patients received gentamicin pre-procedurally (17%) and 110 patients were given gentamicin peri-procedurally by injection into the pocket (65/271, 24%) or gentamicin-impregnated collagen (45/271, 17%). Eight patients received an antibiotic mesh (Tyrx).
Conclusion: The PADIT score is a useful tool to challenge operators’ perceived risks around device procedures. The risk profile across the NECVN is not uniform. The PADIT score offers the opportunity for a more informed patient-tailored decision-making process around CIED procedures. Our data demonstrate a lack of regional consensus for antibiotic choice in patients undergoing CIED insertion.
DH Birnie, Wang J, Alings M, et al. Risk factors for infections involving cardiac implanted electronic devices. J Am Coll Cardiol. 2019;74:2845–54.