# 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.

## Key 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.