Effect of Intra-pocket Antibiotic Injection During Implantation of Cardiac Implantable Electronic Devices on the Prevention of Pocket Infection

Abstract

Background & Objectives: In recent years, the rate of implantation of cardiac implantable electronic devices (CIED) has progressively increased, while the rate of device related infections (DRI) was disproportionately higher. To decrease the chance of DRI, we evaluated the effect of two local antibiotic prophylaxis methods during CIED implantation on preventing pocket infection as the most common DRI. Materials & Methods: This retrospective, multicenter, cohort study included patients who underwent CIED implantation. All patients received intravenous antibiotic one hour prior to operation. Local antibiotic prophylaxis was done for all patients by either of two methods; irrigation of the pocket by Cephalothin, or its injection into the pocket at the end of the procedure via suture line, according to the operator’s preference. Results: From March 2011 to March 2016, 1003 patients underwent CIED implantation. Pocket irrigation by antibiotic was done for 664 cases and antibiotic injection for 339 cases. Infection rate was 1.6% in all patients; 2.3% in irrigation group vs. 0.3% in injection group (P=0.016). There were not significant differences in lead impedance and pacing threshold trend up to 2 months after devices implantation among the patients with two methods of local antibiotic prophylaxis. (P>0.05) Conclusion: Local antibiotic injection via the suture line after CIED implantation may increase prophylactic effect of intravenous antibiotic infusion against DRI.

Keywords

• local antibiotic prophylaxis
• cardiac implantable electronic devices
• device related infection
• pocket infection