Abstract
Infections related to cardiac implantable electronic device (CIED) placement are associated with poor clinical outcomes. As such, preprocedural prophylactic antibiotic therapy is indicated for all patients prior to device insertion. However, the available data are less clear on the impact of postprocedural antibiotic therapy on rates of CIED infection when used in addition to preprocedural therapy. This is single-center, retrospective cohort study of 913 patients who underwent CIED-related procedures between October 2010 and August 2014 sought to compare the rate of CIED infections in patients receiving only preprocedural antibiotics with those receiving both preprocedural and postprocedural antibiotics. Univariate analysis was used to detect independent risk factors for CIED infection. After excluding patients receiving concomitant antibiotics for other conditions, those undergoing CIED extraction alone, and those with a lack of follow-up data and/or adequate documentation of clinical encounters, 569 patients were identified for inclusion in the final analysis. The majority of patients who received postprocedural antibiotics received three to five days of therapy, with the most common antibiotic used being cephalexin. There was no statistically significant difference in the incidence of infection between patients who did and did not receive postoperative antibiotics (4.5% versus 6.1%; p = 0.398). In a multivariate analysis, the use of postprocedural antibiotic therapy was not a significant risk factor for infection (adjusted odds ratio: 0.692; 95% confidence interval: 0.314–1.525; p = 0.361). It is therefore reasonable to withhold prescribing postoperative antibiotics in patients following CIED implantation. Individualized risk factor evaluation of patient comorbidities and procedural characteristics may be needed to aid in determining whether postoperative antibiotics are reasonable in different patients. The validity of these findings is contingent on further confirmation via a prospective, randomized clinical trial.
Highlights
Postoperative Antibiotic Prophylaxis Following cardiac implantable electronic device (CIED) Placement infection parallels this increase and continues to be a serious complication that clinicians must consider during all phases of CIED care.[6]
The primary objective of this cohort study was to compare the rate of CIED infections in patients receiving only preoperative antibiotics with that of those who received preoperative and postoperative antibiotics
Patients were retrospectively reviewed over a 19-year period and separated into different cohorts depending on the CIED antibiotic prophylaxis strategy of the time
Summary
Cardiac implantable electronic devices (CIEDs), including permanent pacemakers (PPMs), implantable cardioverter-defibrillators (ICDs), and chronic resynchronization therapy (CRT) devices, reduce morbidity and mortality in a variety of patient populations.[1,2,3,4] The reported incidence of CIED infection varies from less than 1% to more than 7%, with more recent research suggesting rates of 0.5% to 2.2%.5 As the implantation of CIEDs becomes more widespread, the incidence of CIEDThe Journal of Innovations in Cardiac Rhythm Management, August 2019Postoperative Antibiotic Prophylaxis Following CIED Placement infection parallels this increase and continues to be a serious complication that clinicians must consider during all phases of CIED care.[6]The spectrum of CIED infection ranges from moderate examples, such as superficial surgical site inflammation or generator pocket infection, to more severe or even potentially life-threatening ones like endocarditis or bacteremia.[5,7,8] The more serious CIED infections frequently necessitate hospitalization and the administration of intravenous antibiotics. Cardiac implantable electronic devices (CIEDs), including permanent pacemakers (PPMs), implantable cardioverter-defibrillators (ICDs), and chronic resynchronization therapy (CRT) devices, reduce morbidity and mortality in a variety of patient populations.[1,2,3,4] The reported incidence of CIED infection varies from less than 1% to more than 7%, with more recent research suggesting rates of 0.5% to 2.2%.5. Postoperative Antibiotic Prophylaxis Following CIED Placement infection parallels this increase and continues to be a serious complication that clinicians must consider during all phases of CIED care.[6]. Mortality is higher in those requiring device removal as compared with those who do not develop a infection, and this phenomenon may persist for years after device removal.[5,6,9] These findings signal that the prevention of infection and the minimization of the need for device extraction is of paramount importance in the perioperative setting
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