Efficacy of postoperative antibiotics in CIED infection

Medicine, 2020

Background: Over the past decade, rates of cardiac implantable electronic device (CIED) related infections have increased and been associated with increased morbidity, mortality and financial burden on healthcare systems. Methods: To examine the effect of an antibacterial envelope in reducing major CIED related infections, we performed a systematic review and meta-analysis by searching PubMed/MEDLINE, CENTRAL, Google scholar and Clinicaltrials.gov for studies that examined the effect of an antibiotic envelope in reducing major related CIED infections, comprising of device-related endocarditis, systemic infection requiring systemic antibiotics and or device extraction, compared to control up till February 15th, 2020. A randomeffects meta-analysis was conducted by calculating risk ratios (RR) and respective 95% confidence intervals (CI). Results: We include 6 studies that comprise of 11,897 patients, of which 5844 received an antibiotic envelope and 6053 did not. Compared with control, utilization of an antibiotic envelope at the time of procedure was associated with a significant 74% relative risk reduction in major CIED related infections among patients at high risk for infection (RR: 0.26 [95% CI, 0.08-0.85]; P = .03), while no significant reduction was observed among patients enrolled from studies with any risk for infection (RR: 0.53 [95% CI, 0.06-4.52]; P = .56). Additionally, no reduction in mortality among patients that received an envelope compared to control was observed (RR: 1.15 [95% CI, 0.53-2.50]; P = .72). Conclusion: The utilization of an antibiotic envelope at the time of device implantation or upgrade reduces major CIED infections, especially if used in patients perceived to be at higher risk for infection. Abbreviations: CIED = cardiac implantable electronic device, CRT-D = cardiac resynchronization therapy-defibrillator, CRT-P = cardiac resynchronization therapy-Pacemaker, ICD = implantable cardioverter defibrillator, PPM = permanent pacemaker.

Pacing and Clinical Electrophysiology, 2012

Background Surgical site infections (SSIs) resulting from cardiac rhythm management device (CRMD) implantation cause significant morbidity and mortality worldwide, and appear to be increasing at a disproportionately higher rate than the actual rate of CRMD implantation. The prophylactic administration of antibiotics and antiseptics may reduce this infection rate. Objectives To determine whether the prophylactic administration of antibiotics and antiseptics in patients undergoing CRMD implantation reduces the incidence of SSI.

Pacing and Clinical Electrophysiology, 1984

RAMSDALE, D.R., ET AL.: Antibiotic prophylaxis for pacemaker implantation: A prospective randomized trial. Prophylactic antibiotics are frequently prescribed for patients undergoing permanent pacemaker implantation even though data confirming their effectiveness are limited. Five hundred patients requiring elective permanent pacemaker implantation or generator replacement were prospectively randomized either to receive or not receive prophylactic antibiotic treatment at the time of implantation. The implantation site was treated with 10% povidone-iodine solution and 0.5% alcoholic chlorhexidine preoperatively. The wounds were inspected for evidence of infection at 3 days and 1, 3, 6 and 12 months postimplantation. Three patients (two receiving prophylactic antibiotics and one no antibiotics) developed pacemaker pocket infection; Staphylococcus aureus was the pathogenic organism in each case [P = 0.56). Eighteen patients developed clinical evidence of superficial wound inflammation requiring antibiotic treatment but not pacemaker removal. Six had received prophylactic antibiotics and 12 had not (P = 0.27). We conclude that pacemaker pocket infection is unusual with careful preoperative skin preparation and close postoperative follow-up. Under these circumstances prophylactic antibiotic treatment is of no practical value.

Indian Journal of Microbiology Research, 2023

Cardiovascular implantable electronic devices (CIED) improve quality of life of patients with cardiac arrhythmias and also improves chances of survival. CIEDs, however it may cause complications. To avoid these complications surgical prophylaxis in CIED insertion is required to avoid infection. Due to the rise in antimicrobial resistance the use of antimicrobial agents should be rational and under control. To prevent resistance of antibiotics their use and duration of therapy should be monitored. The high-end and restricted antibiotics should be used only if organisms grow in cultures or if suggested by infectious disease specialists. This review focuses on empirical antibiotics used as prophylaxis. The purpose of this document is to outline the antimicrobial options which can be used as an empirical prophylactic agent in CIED infections. Keywords: Staphylococcus species, Blood culture, Pocket infection

2020

T he number of cardiac implantable electronic device (CIED) procedures in patients with different cardiac rhythm disorders or heart failure has significantly increased worldwide over the past decades and has continued to expand with the growing indications for CIED and population aging. Despite significant progress in technology development and growing operator experience, the rate of device-related complications still remains high. CIED-related infections (CDI) are the most serious complication associated with increased mortality and involve substantial healthcare resources and costs.1,2 The reported CDI occurrence varies between 0.68% and 2.2% of CIED procedures, with significantly higher CDI incidence for implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy (CRT) procedures (up to 4.8%).2–5 Previous studies report several patient-related and procedure-related risk factors for CDI development, but many of them were retrospective analyses with inconsist...

Circulation, 1998

Background —Infection remains a serious complication after permanent pacemaker implantation. Antibiotic prophylaxis is frequently prescribed at the time of insertion to reduce its incidence, although results of well-designed, controlled studies are lacking. Methods and Results —We performed a meta-analysis of all available randomized trials to evaluate the effectiveness of antibiotic prophylaxis to reduce infection rates after permanent pacemaker implantation. Reports of trials were identified through a Medline, Embase, Current Contents, and an extensive bibliography search. Trials that met the following criteria were included: (1) prospective, randomized, controlled, open or blind trials; (2) patients assigned to a systemic antibiotic group or a control group; (3) end point events related to any infection after pacemaker implantation: wound infection, septicemia, pocket abscess, purulent secretion, right infective endocarditis, inflammatory signs, a positive culture, septic pulmona...

Journal of Cardiovascular Medicine, 2014

The increase in incidence/prevalence of infections of implantable pacemakers and defibrillators (implantable cardioverter defibrillator, ICD) is outweighing that of the implanting procedures, mainly favored by the changes in patient profile. Despite the high impact on patient's outcome and related costs for healthcare systems, we lack specific evidence on the preventive measures with the exception of antibiotic prophylaxis. The aim of this study is to focus on common approaches to pacemaker/ICD implantation to identify the practical preventive strategies and choices that can (potentially) impact on the occurrence of this feared complication. After a brief introduction on clinical presentation, pathogenesis, and risk factors, we will present the results from a survey on the preventive strategies adopted by different operators from the 25 centers of the Emilia Romagna region in the northern Italy (4.4 million inhabitants). These data will provide the basis for reviewing available literature on this topic and identifying the gray areas. The last part of the article will cover the available evidence about pacemaker/ICD implantation, focusing on prophylaxis of pacemaker/ICD infection as a 'continuum' starting before the surgical procedure (from indications to patient preparation), which follows during (operator, room, and techniques) and after the procedure (patient and device follow-up). We will conclude by evaluating the relationship between adherence to the available evidence and the volume of procedures of the implanting centers or operators' experience according to the results of our survey.

British heart journal, 1995

Background-Pacemaker pocket infection is a potentially serious problem after permanent pacemaker implantation. Antibiotic prophylaxis is commonly prescribed to reduce the incidence of this complication, but current trial evidence of its efficacy is conflicting. A large prospective randomised trial was therefore performed of antibiotic prophylaxis in permanent pacemaker implantation. The intention was firstly to determine whether antibiotic prophylaxis is efficacious in these patients and secondly to identify which patients are at the highest risk of infection. Methods-A prospective randomised open trial of flucloxacillin (clindamycin if the patient was allergic to penicillin) v no antibiotic was performed in a cohort of patients undergoing first implantation of a permanent pacing system over a 17 month period. Intravenous antibiotics were started at the time of implantation and continued for 48 hours. The trial endpoint was a repeat operation for an infective complication. Results-473 patients were entered into a randomised trial. 224 received antibiotic prophylaxis and 249 received no antibiotics. A further 183 patients were not randomised but were treated according to the operator's preference (64 antibiotics, 119 no antibiotics); these patients are included only in the analysis of predictors ofinfection. Patients were followed up for a mean (SD) of 19(5) months. Among the patients in the randomised group there were nine infections requiring a repeat operation, all in the group not receiving antibiotic (P = 0.003). In the total patient cohort there were 13 infections, all but one in the non-antibiotic group (P = 0.006).

Pacing and Clinical Electrophysiology, 2011

Methods: This study enrolled consecutive CIED procedures utilizing the antibacterial envelope at 10 US academic, community, and Veterans Affairs medical centers. Procedures following an explantation for a prior CIED infection or off-label use of the antibacterial envelope were excluded.

Circulation: Arrhythmia and Electrophysiology, 2009