Preventing cardiac implantable electronic device infections

Prevention of Cardiac Implantable Electronic Device Infections: Single Operator Technique with Use of Povidone‐Iodine, Double Gloving, Meticulous Aseptic/Antiseptic Measures and Antibiotic Prophylaxis

“…The issue of prophylactic antibiotic treatment has not been definitely settled; however, the recommendation for at least preprocedural use of an intravenous antibiotic has been widely accepted and recommended . The need for postprocedural antibiotic use remains dubious, is not recommended by current guidelines, and is the subject of ongoing trials; however, it served well in a prior large prospective database study and in the present series without apparent problems observed. The duration of 4–5 days postoperatively was arbitrarily chosen with 48‐hour intravenous in‐hospital administration followed by a 2‐ to 3‐day home regimen and has been steadily applied and followed through over the years.…”

“…Several other risk factors have been associated with CIED infection and these should be explored and minimized as much as possible . Implementation of an infection prevention program, such as the protocol applied in this and other studies or recommended by guidelines, can be very effective in drastically reducing CIED infection rates (Fig. ).…”

“…Clearly the optimal approach to this intricate problem is prevention of such a dreaded complication . Prophylactic antibiotics have had a significant impact on the incidence of device infection, but have not entirely eliminated the problem of infection . A combined approach of a lege artis implantation technique together with antibiotic administration might enhance the efficacy of preventive measures.…”

Periprocedural Antibiotic Prophylaxis for Cardiac Implantable Electrical Device Procedures

“…Despite the morbidity of CIED infections and the need for meticulous adherence to evidence-based prevention, there is no high-quality evidence to support the practices of post-procedure antibiotic administration and antibiotic irrigation identified in our survey (3,4,6). Approaches to managing suspected MRSA-colonization—a risk factor for MRSA infection—similarly conflict with guidelines (3).…”

“…Use of perioperative antibiotics is the standard of care for CIED implantation (3), but there are no high-quality data supporting antibiotic prophylaxis after the closure of the incision for CIED implantation or any other surgical procedure (4). Thus, guidelines recommend only a single dose of pre-incision prophylactic antibiotics for CIED placement (3,5).…”