The goal of the study is to compare whether a center-wide policy of incremental antibiotic therapy will reduce CIED infection rate compared to a policy of conventional antibiotic prophylaxis in high-risk patients undergoing arrhythmia device procedures. All antibiotics used are approved for use and readily available.
This is a randomized prospective cluster crossover trial to track outcomes of high infection risk patients undergoing arrhythmia device procedures. Centres will be randomized to either conventional antibiotic therapy or incremental antibiotic therapy. Patients will not be randomized. Centres will be randomized to one therapy and then cross over to the next after 6 months. At one year they will randomize again and then cross over for the final time at 18 months. During each treatment period the randomized antibiotic therapy will be used on all centre patients undergoing a device implant procedure. Ethics approval has been obtained in all sites for waiver of consent with notification of the study (i.e. data collection is taking place to track infection rates). A third of sites obtain consent after the procedure for collection of data (but not for care, since either arm is the standard of care).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
NONE
Enrollment
12,814
Single dose of Cefazolin and Vancomycin preoperatively, bacitracin wash and cefalexin post operative.
Cefazolin preoperative
Coordinating Centre: Population Health Research Institute
Hamilton, Ontario, Canada
Hospitalization attributed to device infection
Time frame: Evaluation is one year post patient's procedure
1. Proven device infection not requiring surgical intervention (medically treated device infection).
Time frame: Up to one year post procedure
2. Any treatment with antibiotics for suspected device infection.
Time frame: Up to one year post procedure
3. Antibiotic-related adverse events including culture or antigen proven C. difficile infection.
Time frame: Up to one year post procedure
4. Prolongation of hospitalization due to proven or suspected adverse events from the antibiotic therapy.
Time frame: Up to one year post procedure
Cost benefit analysis
Time frame: At completion of data collection period
6. Rate of device/lead extraction 12 months post patient's procedure (regardless of the cause).
Time frame: Up to one year post procedure
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