Prophylactic Antibiotics Do Not Benefit Patients Receiving IVADs

Lara C. Pullen, PhD

April 11, 2011

April 11, 2011 (Chicago, Illinois) — The risk for early infection in patients who receive implantable venous access devices (IVADs) in the absence of prophylactic antibiotics is less than 1%. This infection rate compares favorably with the early infection rate seen in patients receiving IVADs with prophylactic antibiotics.

Anne Covey, MD, FSIR, from Memorial Sloan-Kettering Cancer Center in New York City, presented the results of a retrospective chart review here at the Society of Interventional Radiology 36th Annual Scientific Meeting.

Dr. Covey began by explaining that the placement of IVADs is an increasingly common procedure in interventional radiology. She explained to Medscape Medical News that "there is not a whole lot of literature out there about whether to give antibiotics or not." She concluded by noting that the implications of this study are great when one considers that there are 5 million central lines placed in patients each year in the United States.

She and her colleagues queried the Picture Archiving and Communication System at the Sloan-Kettering Cancer Center to obtain a list of 1158 patients who received IVAD placement in 2009. Of these patients, 820 (71%) were receiving antibiotics incidental to the procedure at the time of placement. The Picture Archiving and Communication System documented the removal of 13 (1.1%) of the IVADs and indicated that 37 (3.2%) of the patients died within 30 days of implantation. Of the patients whose IVAD was removed within 30 days, 7 (0.6%) had a bloodstream infection.

Roy L. Gordon, MD, head of quality and safety in radiology at the University of California, San Francisco, was not involved in the study, but he shared his perspective with Medscape Medical News: "I don't find it at all surprising." He suggested that physicians discontinue the use of prophylactic antibiotics except in patients who are of great risk for infection, such as those who are immunocompromised or who have low white blood cell counts.

Dr. Covey explained that "the big deal is downstream. The big deal is when you are treating a [methicillin-resistant Staphylococcus aureus infection] instead of a simple staph infection." She added: "We do not give prophylactic antibiotics, but I believe we are in the minority."

Dr. Covey and Dr. Gordon have disclosed no relevant financial relationships.

Society of Interventional Radiology (SIR) 36th Annual Scientific Meeting: Abstract 91. Presented March 28, 2011.


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