Postoperative antibiotic prophylaxis in the prevention of cardiac implantable electronic device infection

Abstract

Background The aim of the present study was to determine whether postprocedural antibiotic reduces the risk of infection related to the cardiac implantable electronic device (CIED) implantations. Methods The present investigation is a randomized, prospective, single‐blinded controlled trial. All consecutive patients who presented for new CIED implantation, generator replacement, or upgrade were randomized into the following three groups: (A) no antibiotic, (B) intravenous (IV) antibiotic for 1 day, (C) 1 day IV plus 7 days oral antibiotic. Follow‐up was performed on 10‐12 days; 1, 3, 6 months; and then every 6 months for 2 years. The primary endpoint was any evidence of infection at the generator pocket or systemic infection related to the procedure at short‐term (6‐month) and long‐term (2‐year) follow‐ups. Results Of the 450 patients (72 patients with cardiac resynchronization device) included in the study, the primary endpoint of short‐term infection was reached in one patient (0.2%) in group A and no patients in groups B and C. The endpoint of long‐term infection was reached in nine patients (2%) with equal frequency between three randomized groups (three patients in each group). On multivariable analysis, the only independent predictor of infection was defibrillator implantation (odds ratio, 8.5; 95% confidence interval, 1.6‐45). Conclusions The results of this prospective study showed no benefit for the postoperative antibiotic for the prevention of CIED infection.

There is no tailored approach for antibiotic prophylaxis after the device implantation

“…We appreciate Dr. Canpolat's interest in our article on postoperative antibiotic prophylaxis in prevention of cardiac implantable electronic device (CIED) infection, which was recently published in the journal of Pacing and Clinical Electrophysiology . We agree that there was no standard recommendation on the postoperative use of prophylactic antibiotic for prevention of CIED infection.…”

Gap in knowledge

“…We have read with great interest the article entitled “Postoperative Antibiotic Prophylaxis in Prevention of Cardiac Implantable Electronic Device Infection” by Madadi et al in the latest issue of the journal . The authors have presented their clinical data regarding cardiac implantable electronic device infection with and without prophylactic antibiotics in a randomized, prospective manner.…”

Tailored antibiotic prophylaxis in patients undergoing CIED implantation: One size does not fit all the principle

“…Last, the patients with impaired renal functions should be included and emphasized because of the immune compromised condition of these patients, which was also known as a predictor of future CIED infections appropriately . Finally, although the study by Madadi et al . as a randomized design highlights some parts more clearly, it should be interpreted carefully.…”