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Prophylactic intravenous antibiotic reduces infections in patients undergoing cardiac implantable electronic devices (CIEDs) implantations. However, there are few data regarding impact of post procedures antibiotic on outcomes. On the basis of this reasoning, most patients undergoing CIEDs implant at KAUH over the past 2 years have not received antibiotic post procedure. We sought to quantify our experience with this approach.
We retrospectively reviewed all charts of patients who underwent CIED implantation between February 2014 and August 2016 at KAUH. For each patient, data were abstracted regarding the type of device implanted, demographics, functional class and the presence or absence of coexisting medical disorders. For every follow-up visit, the presence or absence of local pocket infection and systemic infection were noted. For patients not being followed at our center, telephone contact was made with the patient to ascertain the date of their last review.
One hundred and forty-five patients underwent CIED implant during the period of February 2014 and August 2016. The charts of 138 patients were available for review. Ninety-one (66%) patients were male and mean age was 61 +/- 12 (range 23-86). Seventy-six (55%) patients had diabetes and 22 (16%) were hypertensive. The NYHA functional class was documented in 105 patients; most were class 2 (46/105; 44%) or class 3 (34/105; 32%) while 24 (23%) were class 1, and 1 patient was class 4. We included only the patients with a new CIED implant and excluded patients with end stage renal disease, intubated patients, patients on Immunosuppressant drugs and patients with active cancer. Thirty (22%) patients had a single chamber pacemaker, 37 (27%) had a dual chamber pacemaker, 21 (15%) had a single chamber ICD, 27 (19.5%) had a dual chamber ICD and 23 (16.5%) patients had a biventricular ICD. All patients received pocket irrigation with saline solution only. Of the 138 patients, 2 (1.4%) patients had CIED pocket infection. The mean duration of follow-up in these patients was 156 days (range: 29-507 days). Implant to infection time in those 2 patients were 67 and 156 days respectively, and all of them underwent devices and leads extraction, with re-implantation on the contralateral side. No systemic infections or mortality were noted due to infectious complications. Seven Patients had no follow-up and two patients died during the follow-up periods.
A no post-procedure antibiotic strategy in patients receiving a new CIED has been associated with a very low rate of local infection. A prospective study examining the value of post-procedure antibiotic is warranted.