Prevention of Device Infection: Procedural Aspects, Drugs, and Preventive Tools

A Historical Perspective of Cardiac Implantable Electronic Device Infection: How a Menace Can Drive Technological and Clinical Improvement

“…Both intervention arms performed better than the control groups, but only the WRAP-IT trial reached significance in terms of reduction of CIED infections, albeit with a number needed to treat (NNT) score of 200. Importantly, both studies were characterized by an incidence of CIED infections in the control arm that was significantly lower than expected, similar to more recent observational data [25], evidencing that, despite the usefulness of prolonged antibiotic prophylaxis to reduce CIED infections, it should be remembered that preventive strategies should consider all the various aspects of CIED therapy, from patient selection to implanting procedure and follow-up [14,26]. In this regard, the management of CIED infections should be considered a complex issue, from diagnosis to the decisions for device extraction and re-implantation.…”

“…The authors underlined that in the period between 1996 and 2003, which was characterized by no significant changes in the demographic profile of patients receiving CIED implantation, hospitalizations for CIED infections increased 3.1-fold (2.8-fold for PMs and 6-fold for ICDs). Notably, the only factor that changed during the same period was the type of implanted CIED, with an increase of ICDs vs. PMs (from 14% to 27%, p < 0.001) (Figure 2) [14]. A possible explanation for this phenomenon can be provided by the disproportion between survival of ICD and PM recipients vs. implanted devices.…”