Strategies to Prevent Cardiac Implantable Electronic Device Infection

Abstract

The association between the risk of mortality and cardiovascular implantable electronic device (CIED) infections has been well-established in the literature. As CIED implantations have increased in frequency in the past few decades, the incidence of CIED-related infections has also risen. Given the morbidity, mortality, and health-care costs associated with CIED infections, the prevention of device-related infection is a critical goal. Risk factors for developing CIED infections can be categorized as patient-, procedure-, or device-related. Numerous studies have highlighted different strategies for preventing CIED-related infections, which include patient optimization, device selection, and periprocedural preparation and treatment. Nonetheless, as the comorbidity burden of patients undergoing CIED implantation continues to increase, significant challenges in the successful elimination of CIED-related infections remain. This review provides a comprehensive overview of available evidence-based approaches and strategies to reduce the risk of CIED infections.

Six months clinical outcome comparison between quadripolar and bipolar left ventricular leads in cardiac resynchronization therapy: A prospective, non-randomized, single-centre observational study

“…Prevention of DRI is challenging and can be reduced with proper preparation of patient and lab before CRT implantation, using quadripolar lead to avoid chances of re-intervention. Newer modalities like the use of antibiotic envelope during pacemaker implantation have shown to be effective for the prevention of DRI and is a subject of further evaluation [ 37 ].…”

Antibiotic eluting envelopes: evidence, technology, and defining high-risk populations

“… 30 , 31 The number needed to treat in the WRAP-IT trial was 200 while the base incremental cost-effectiveness of the TYRX AE was $112 603 per quality-adjusted life year. 32 , 33 However, the cost-effectiveness of the AE was far more pronounced in certain subgroups such as those with prior CIED infection, history of immunocompromise, two or more prior procedures for those with a high power device, history of renal dysfunction, or undergoing a revision or upgrade 33 ( Figure 1 ).…”

“… 21 , 38 Finally, end-stage renal disease is one of the most powerful determinants of risk for CIED infection, but perhaps that risk will not be significantly impacted by an intervention with demonstrable effect against pocket infection, but no significant effect on endovascular infection. 15 , 16 , 21 , 32 , 39 Future studies including planned analyses of the WRAP-IT data should further clarify the role of AEs.…”

Anti-biofilm activity of antibiotic-loaded Hylomate®

“…There has been a 95% rise in numbers of cardiac implantable electronic device (CIED) implantations between 1993 and 2008 [1] , which has, in turn, been associated with a higher burden of device replacement, generator change-outs, and upgrade/revision surgeries. The incidence of CIED infection has increased in parallel, with infection being a particular burden among those with underlying comorbidities [2] . CIED infections carry significant morbidity and mortality.…”

“…Several strategies to limit CIED infection have been proposed, including proper selection of patients for CIED placement, optimization of aseptic technique, administration of antibiotics at the time of device implantation, and use of antibiotic-coated implantable devices [2] . The last is intended to reduce or eliminate bacteria accessing device surfaces during implantation surgery, and includes antibacterial envelopes designed to release antimicrobial drugs directly into the CIED generator pocket [8] , [9] , [10] .…”