Contemporary practice about cardiac implantable electronic device infections prevention: A French multicenter survey

TL;DR

A survey of French hospitals shows inconsistent adherence to guidelines for preventing infections from heart implant devices, including antibiotic use and new envelope technology.

Contribution

This study provides the first multicenter survey in France on real-world adherence to cardiac device infection prevention guidelines, including novel AEE usage.

Findings

Only 59.5% adherence to European Society of Cardiology infection prevention guidelines was observed.

TYRX antibiotic-eluting envelopes were not systematically used in reimbursed cases (42.4%).

Most hospitals tracked infection incidence on a case-by-case basis (54.5%).

Abstract

Cardiac implantable electronic device 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.

This study aimed to assess infection prevention practices across French hospital centers, with a particular focus on the recent European Society of Cardiology recommendations regarding AEE use.

Data were collected from 33 French centers (51.3% private, 21.2% academic, 27.3% general hospitals). Each practitioner reported data for 5 patients. A structured questionnaire, validated by 2 international experts, addressed key prevention strategies with specific emphasis on AEE.

Infectious risk assessment was systematically performed, occasionally using risk scores (Prevention of Arrhythmia Device Infection Trial 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 C-reactive protein measurement was more common (63.6%). Intravenous antibiotic prophylaxis was reported in 93.9% of cases, administered within 1 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%.

This multicenter French survey highlights substantial gaps in physicians’ knowledge and application of cardiac implantable electronic device infection prevention practices, despite the availability of clear European Society of Cardiology guidelines.

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