ANTIBIOTIC THERAPY IN POST-EXTRACT PATIENTS

Abstract

Abstract Introduction With the increase in complications associated with the implantation of pacemakers and defibrillators, the number of patients who undergo transvenous extraction of leads following infection has increased. Often, in pacemaker-dependent patients there is the problem of having to carry out an early reimplantation after extraction. This study aims to evaluate the incidence of reinfection in post-extracted patients treated with antibiotic therapy and reimplanted with a second device. Methodology To demonstrate the reduction in infection recurrences, a follow-up was carried out on all patients extracted in our center, differentiating between patients reimplanted with a second device who underwent targeted antibiotic therapy before and after surgery and patients reimplanted without targeted pre-extraction antibiotic coverage due to the failure to identify a specific germ. Results 184 device extraction procedures performed due to infection in our center were considered. In 100 patients the need arose to reimplant a second device at the same time as the extraction procedure. Among these patients, 33, in whom the germ of the infection was known, were treated with pre- and post-procedure antibiotic therapy, while in 24 patients no pre-extraction antibiotic therapy was carried out as they did not have a targeted antibiotic and in waiting for a positive blood culture. 4 patients, however, were treated with empirical therapy, which was then updated post-extraction following the results of the analysis of the extracted material. Subsequently, a follow-up was carried out to evaluate any recurrence of infections and it emerged that: a recurrence of infection occurred in 6% of patients treated with targeted antibiotics pre- and post-extraction and in 4% of patients treated with antibiotics only post-extraction -extraction. Among the 4 patients treated with empiric antibiotic therapy, 1 had a recurrent infection. Conclusions From this study it was possible to demonstrate that targeted antibiotic therapy also made it possible to limit infections in the short and long term even in patients who, not having positive blood cultures before the extraction procedure, underwent the therapy only following the results obtained by the extracted material, without the use of empirical antibiotic therapy.