CIED Infection Pathogens & Prophylaxis

Coagulase (-) Staphylococcus (e.g. S. epidermidis) and S. aureus are responsible for about 70% of CIED infections1-6 and nosocomial isolates of these pathogens are becoming increasingly resistant to methicillin (equivalent to cefazolin resistance):7,8

 

 

        Nosocomial Infection Isolates 

•  AHA/HRS 2010 Recommendations for Antimicrobial Prophylaxis at the time of CIED placement9

Class I

1. Prophylaxis with an antibiotic that has in vitro activity against staphylococci should be administered.  If cefazolin is selected for use, then it should be administered intravenously within 1 hour before incision; if vancomycin is given, then it should be adminstered intravenously within 2 hours before incision. (Level of Evidence: A) 

•  Although systemic antibiotic prophylaxis can significantly reduce CIED-related infections3...cefazolin and vancomycin have important clinical deficiencies when used as a single agent.

 

 

Additional notes on cefazolin and vancomycin:
•    Cefazolin and vancomycin are rarely used in combination
•    Substantial overlap (both have activity against gram (+) organisms)
•    Neither has strong profile against gram (-) organisms 
 

  1. Klug D et al. Circulation. 2007:116(12):1349-1355. 
  2. Lekkerkerker JC et al. Heart. 2009:95(9):715-720.
  3. de Oliveira JC et al. Circ Arrhyth Electrophysiol. 2009:2(1):29-34.
  4. Da Costa A et al. Circulation. 1998:97(18):1791-1795.
  5. Chua J et al. Ann Intern Med. 2000:133(8):604-608. 
  6. Sohail, MR et al. J Am Coll Cardiol. 2007:49(18):1851-1859.
  7. Wisplinghoff et al. SCOPE Study Group. Clinical Infectious Disease 2004 39(3),309-317.
  8. NNIS System Report: Am J Infect Control 2004:32(8),470-485.
  9. Baddour LM et al. Circulation 2010;121(3):458-477.
  10. Gilbert DN et al. The Sanford Guide to Antimicrobial Therapy 2008 (38th Edition) Antimicrobial Therapy Inc., Hyde Park, VT.
  11. Zinner SH et al. J Infect Dis. 1981:(144):365-371.
  12. Darouiche RO et al. Int J Antimicrob Agents. 1995:(6):31-36.
  13. Segreti J et al. Diagn Microbiol Infect Dis. 1989:(12):253-255. 

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