Use of antimicrobial agent pocket irrigation for cardiovascular implantable electronic device infection prophylaxis: Results from an international survey

Zheng, Qi; Biase, Luigi Di; Ferrick, Kevin J.; Gross, Jay N.; Guttenplan, Nils; Kim, Soo G.; Krumerman, Andrew; Palma, Eugen C.; Fisher, John D.

doi:10.1111/pace.13473

Cited by 11 publications

(12 citation statements)

References 51 publications

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“…7 Trends among implanters regarding pre-operative antibiotic use are consistent with previously reported rates. 8 Specifically, the 97% of respondents utilizing appropriate antibiotics targeting Staphylococcal species fall in line with current guidelines set by the Class I level of evidence (LOE) A recommendation set by the American Heart Association. 9 However, our results also highlight the wide discrepancies seen with use of post-operative use of systemic antibiotics.…”

Section: Discussionmentioning

confidence: 86%

A Survey of Antibiotic Use During Insertion of Cardiovascular Implantable Devices Among United States Implanters

et al. 2022

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Antibiotic use for cardiovascular implantable devices (CIED) prophylaxis is well-accepted despite a paucity of data. Pre-procedural prophylaxis lowers the rate of CIED infections; however, data is lacking for intra- or post-procedural antibiotic use. Antibiotic-eluting envelopes (ENVELOPE) [TYRX®TM] have been shown to reduce post-procedural infections. Understanding implanter practices may provide insight as to the need for antibiotic stewardship. The purpose of this survey was to assess the practices of implanters nationally. A survey was completed by 150 implanters across the US. Participants were board certificated, implanters of CIEDs, with varying experience (1–25 years), in various hospital settings. Of the respondents, 97% reported routine use of systemic antibiotics pre-operatively. About two-thirds of implanters continue systemic antibiotics post-operatively, with half continuing antibiotics for >24 h; 83% of implanters add antibiotic to saline for the purpose of irrigating the wound; 55% routinely use ENVELOPE on approximately 38% of patients. Common reasons cited for ENVELOPE use were infection concerns, significant risk factors, prior device infection, and immunosuppressed status. Two-thirds of respondents use systemic antibiotics during generator changes, with >50% continuing antibiotics for >24 h. This study suggests wide variations in practice among implanters. Additional attention to existing guidelines and evidence regarding appropriate use of ENVELOPE is still needed.

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Section: Discussionmentioning

confidence: 86%

A Survey of Antibiotic Use During Insertion of Cardiovascular Implantable Devices Among United States Implanters

et al. 2022

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“…Even though the current guidelines did not recommend pocket irrigation with antibiotics to reduce pocket infection, one of the international surveys suggested that pocket irrigation with antibiotics during implantation is widely used in current practice (54% believe in the effectiveness of antibiotic pocket irrigation to reduce CIED infection; 33% are uncertain, and few consider this strategy ineffective 13% or offered no opinion) ( 20 ). A recent meta-analysis demonstrated a significantly protective effect on preventing PM infection with antimicrobial pocket irrigation, regardless of antimicrobial class ( 21 ).…”

Section: Discussionmentioning

confidence: 99%

Antibiotic Prophylaxis and Treatment in Early Cardiac Implantable Electronic Devices Infection

Alshoubaki¹,

Darabaa²,

Odat³

et al. 2021

Med Arch

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Background: Cardiac implantable electronic devices – PM, ICD, and CRTs- are well-proven life-sustaining and the ultimate destination for many heart conditions. Based on scientific evidence, there is a worldwide incremental increase in CIED implantations numbers. Objective: Early infection of cardiac implantable electronic devices (CIED)– pacemaker (PM), implantable cardioverter-defibrillator (ICD), and cardiac resynchronization therapy (CRT)– is a growing health challenge. We examined the effectiveness of antibiotic prophylaxis and treatment of early infection of CIED in a single center. Methods: This is a retrospective, single-center observational study. Data were collected from patients’ records from July 2017-July, 2019. All Patients received intravenous ceftriaxone 2gm before incision, Gentamicin 120mg pocket irrigation, and oral Amoxicillin/Clavulanate for 5 days post-implantation. Results: A 639 consecutive CIED implantations – PM (n=474, mean age, 64yr, female=49%), ICD (n=106, mean age 56yr, female=17%) and CRT (n=59, mean age, 54yr, female=20%)- were performed over 3years. The incidence of early infection was 1.9% (12 cases), female=41%. PM=5/474, ICD=5/106, and CRT=2/59. Three out of the 12 patients had total device explant due to pocket abscess; one PM had a generator changed; one ICD who had a pneumothorax, and the third one had reimplantation after ICD lead perforation. Nine cases were managed conservatively using saline dressing and oral Amoxicillin/Clavulanate, 3/9 patients developed a hematoma, 4/9 patients developed purulent suture line infection. None of them had infection recurrence on three months follow up. Conclusion: Early infection of CIED is a rare complication with multiple predisposing factors. Our protocol is reassurance and prompt initiation of management protocol to prevent and treat this issue’s sequences.

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“…The most commonly chosen antibiotics are Bacitracin (48%), vancomycin (39%), and cephalosporin (29%). [20] Kang et al [21] conducted a metaanalyses, including 10 studies, to investigate the protective effects of pocket irrigation regardless of antibiotics classes. The incidence of pocket infection decreased by about 59% with antibiotic irrigation compared with the use of saline.…”

Section: Discussionmentioning

confidence: 99%

Cardiac Implantable Electronic Device Infections: A Single Tertiary Care Center Experience

Bozyel¹

2020

South Clin Ist Euras

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The rate of cardiac implantable electronic device (CIED) infections has become prevalent in recent years, and they are related to severe complications, as well as a cost burden. In the present study, we assessed the results of our single tertiary care center experience. Methods: All patients who underwent CIEDs implantation between 2012 and 2018 with procedural and follow-up data available were included in this study. Results: Device infection was defined in six of 512 patients aged from 29 to 78 years old. The mean follow-up period was 2.8±1.7 years. They were new implants and system, removal which included a generator, and all transvenous leads were carried out for five cases. Removal of the generator and debridement of the pocket was performed in one case with isolated pocket erosion without local signs of infection and the wound was irrigated with antibiotic solution. A 2-week oral antibiotic therapy was administered to all patients following discharge. After reimplantation, there was no infection recurrence in three patients during 13±6.1 months follow-up period. Baseline characteristics, with the exception of implanted device types, were similar between infected and non-infected patients. Hematoma or pneumothorax was not observed in patients with device infection. Conclusion: Prevalent risk factors for device infections were not relevant to our patients. Our device infection rates (1.17%) were slightly lower, and there was no serious complication due to the device infection itself or its management.

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Use of antimicrobial agent pocket irrigation for cardiovascular implantable electronic device infection prophylaxis: Results from an international survey

Abstract: This international survey suggests that, while there are little clinical data to support or discourage such practice, the usage of antimicrobial agent pocket irrigation for CIED infection prophylaxis is widely used in current practice.

Cited by 11 publications

References 51 publications

A Survey of Antibiotic Use During Insertion of Cardiovascular Implantable Devices Among United States Implanters

A Survey of Antibiotic Use During Insertion of Cardiovascular Implantable Devices Among United States Implanters

Antibiotic Prophylaxis and Treatment in Early Cardiac Implantable Electronic Devices Infection

Cardiac Implantable Electronic Device Infections: A Single Tertiary Care Center Experience

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