Contemporary practice about cardiac implantable electronic device infections prevention a french multicenter survey
A Da Costa, M Goralski, A Guiot, I Lecardonnel, J C DeharoAbstract
Background
Cardiac implantable electronic device (CIED) infections remain a major complication. Preventive measures include antiseptic skin preparation, systemic antibiotic prophylaxis, and more recently the use of the absorbable TYRX™ antibiotic-eluting envelope (AEE). Despite explicit international recommendations, real-world adherence to guidelines is insufficiently documented.
Objectives
This study aimed to assess infection prevention practices across French hospital centers, with a particular focus on the recent European Society of Cardiology (ESC) recommendations regarding AEE use.
Methods
Data were collected from 33 French centers (51.3% private, 21.2% academic, 27.3% general hospitals). Each practitioner reported data for five patients. A structured questionnaire, validated by two international experts, addressed key prevention strategies with specific emphasis on AEE.
Results
Infectious risk assessment was systematically performed, occasionally using risk scores (PADIT 12.1%; Charlson 3%). Annual infection incidence was most often tracked on a case-by-case basis (54.5%). Screening for Staphylococcus aureus carriage was infrequent (18.2%), whereas systematic CRP measurement was more common (63.6%). Intravenous antibiotic prophylaxis was reported in 93.9% of cases, administered within one hour before implantation in 77.4%. Skin preparation with 2% alcoholic chlorhexidine and pocket irrigation with physiological saline were both used in 39.4% of cases. AEE was not systematically applied in reimbursed indications (42.4%), with an overall adherence rate to recommendations of 59.5%.
Conclusions
This multicenter French survey highlights substantial gaps in physicians’ knowledge and application of CIED infection prevention practices, despite the availability of clear ESC guidelines.CIED infections prevention actionsGraphical Picture French CIED Prevention