Low‐budget, single‐session elimination of CIED pocket infection

Abstract

Background The dramatic increase in the use of cardiovascular implantable electronic devices (CIED) was associated with an increased rate of CIED infection, which has a high management cost. Aim of the Study To test the safety and efficacy of a single‐session protocol, aiming to reuse the infected pocket side and the same device and leads in patients with CIED pocket infection. Patients and Methods We included patients with isolated pocket infection between January 2015 and November 2019. The Patient was prepared by taking a swab for culture and sensitivity before the procedure. The pocket was debrided and the capsule was removed, the pocket was rinsed with povidone‐iodine and hydrogen peroxide mixture, then packed with gauze sponge soaked with povidone‐iodine. The device was debrided using ultrasonic irrigation and sterilized using gas plasma. The device was reimplanted and the wound was closed in layers. Results During the period of the study, we had 12 patients with isolated pocket infection. Nine presented with erosion, two with impending erosion, and one with a chronic sinus. Patient's age was 61.5 ± 7.64 years. The infection was diagnosed 14.2 ± 8.22 weeks post device implantation. They were admitted for 7.6 ± 1.54 days postprocedure. The follow‐up duration was 26.5 ± 15 (1.7–52) months. Only one patient (8%) had a recurrence of the infection after 50 days of the procedure. Conclusion Our protocol was successful in treating 92% of device‐related pocket infection without the need to replace the device or the pocket side.

Uncovering the Benefits of Povidone Iodine Compared to Other Therapeutic Agents in Wound Infection Prevention and Healing Outcomes: A Scoping Review

“… Open extremity fracture post-operative wound 10% aqueous PV-I (n=828) 4% chlorhexidine gluconate (n=810) 5 Skeith et al (2021) 17 USA A retrospective study PI: 48.7±12.2 Non-PI: 48.1±12.2 To evaluate the effectiveness of pre-operative vaginal preparation with PV-I or chlorhexidine before hysterectomy in reducing the incidence of post-operative infection problems. Hysterectomy wound PV-I (n=2935) Chlorhexidine (n=2935) 6 Roshdy et al (2021) 30 Egypt A retrospective study 45–72 To assess the effectiveness of PV-I and hydrogen peroxide on the single-session protocol of CIED pocket infection elimination. CIED pocket infection 10% PV-I 3% hydrogen peroxide 7 Roberto et al (2021) 28 USA A retrospective study 1.6–21 To investigate if PV-I irrigation, intrawound vancomycin powder, or a combination of these treatments could reduce infection rates after paediatric deformity surgery.…”

Salvage of infected cardiac implantable electronic device with taurolidine—a case report

“…CIED salvage is an attractive alternative management strategy if it could be made more effective in "eradicating" infection, in the sense of no recurrence of overt clinical infection even if dormant bacteria colonisation remains [21]. CIED salvage may have been successful in anecdotal reports [7,8], but was not consistently effective in larger series [6]. The antimicrobial agents which have been used for pocket irrigation and in situ hardware sterilisation include diluted povidone-iodine, diluted hydrogen peroxide, diluted alcohol and antibiotic solutions.…”

“…However, this radical treatment strategy might not always be feasible due to patient and resource factors, in which case an attempt could be made to salvage the infected CIED system [6]. Successful salvage of infected CIED system with in situ sterilisation of the contaminated hardware has been reported [7,8].…”

Salvage of Cardiac Implantable Electronic Device Pocket Infection with Skin Erosion in Frail 92-Year-Old

“…When a CIED is colonised by pathogens, total device system removal (including lead extraction) is the standard of care [ 3 ]. However, under rare circumstances, it would be preferable (if possible) or clinically necessary to make an attempt at salvaging the infected system to avoid its total removal [ 8 , 9 ]. Even if dormant sub-clinical bacterial colonisation remains, [ 21 ] as long as there is no overt clinical infection, this would be an acceptable clinical outcome.…”

“…However, alternative management options might be necessary in certain situations. Successful salvage of infected CIED systems with in situ sterilisation of the contaminated hardware has been reported [ 8 , 9 ]. We herein report the successful salvage of an exposed CIED pulse generator which had eroded through the skin and became contaminated with multiple microbes in a frail patient with taurolidine.…”