TY - JOUR
T1 - Regional Antibiotic Delivery for Implanted Cardiovascular Electronic Device Infections
AU - Topaz, Moris
AU - Chorin, Ehud
AU - Schwartz, Arie Lorin
AU - Hochstadt, Aviram
AU - Shotan, Avraham
AU - Ashkenazi, Itamar
AU - Kazatsker, Mark
AU - Carmel, Narin Nard
AU - Topaz, Guy
AU - Oron, Yoram
AU - Margolis, Gilad
AU - Nof, Eyal
AU - Beinart, Roy
AU - Glikson, Michael
AU - Mazo, Anna
AU - Milman, Anat
AU - Dekel, Michal
AU - Banai, Shmuel
AU - Rosso, Raphael
AU - Viskin, Sami
N1 - Publisher Copyright:
© 2023 American College of Cardiology Foundation
PY - 2023/1/17
Y1 - 2023/1/17
N2 - Background: Present guidelines endorse complete removal of cardiovascular implantable electronic devices (pacemakers/defibrillators), including extraction of all intracardiac electrodes, not only for systemic infections, but also for localized pocket infections. Objectives: The authors evaluated the efficacy of delivering continuous, in situ–targeted, ultrahigh concentration of antibiotics (CITA) into the infected subcutaneous device pocket, obviating the need for device/lead extraction. Methods: The CITA group consisted of 80 patients with pocket infection who were treated with CITA during 2007-2021. Of them, 9 patients declined lead extraction because of prohibitive operative risk, and 6 patients had questionable indications for extraction. The remaining 65 patients with pocket infection, who were eligible for extraction, but opted for CITA treatment, were compared with 81 patients with pocket infection and similar characteristics who underwent device/lead extraction as primary therapy. Results: A total of 80 patients with pocket infection were treated with CITA during 2007-2021. CITA was curative in 85% (n = 68 of 80) of patients, who remained free of infection (median follow-up 3 years [IQR: 1.0-6.8 years]). In the case-control study of CITA vs device/lead extraction, cure rates were higher after device/lead extraction than after CITA (96.2% [n = 78 of 81] vs 84.6% [n = 55 of 65]; P = 0.027). However, rates of serious complications were also higher after extraction (n = 12 [14.8%] vs n = 1 [1.5%]; P = 0.005). All-cause 1-month and 1-year mortality were similar for CITA and device/lead extraction (0.0% vs 3.7%; P = 0.25 and 12.3% vs 13.6%; P = 1.00, respectively). Extraction was avoided in 90.8% (n = 59 of 65) of extraction-eligible patients treated with CITA. Conclusions: CITA is a safe and effective alternative for patients with pocket infection who are unsuitable or unwilling to undergo extraction.
AB - Background: Present guidelines endorse complete removal of cardiovascular implantable electronic devices (pacemakers/defibrillators), including extraction of all intracardiac electrodes, not only for systemic infections, but also for localized pocket infections. Objectives: The authors evaluated the efficacy of delivering continuous, in situ–targeted, ultrahigh concentration of antibiotics (CITA) into the infected subcutaneous device pocket, obviating the need for device/lead extraction. Methods: The CITA group consisted of 80 patients with pocket infection who were treated with CITA during 2007-2021. Of them, 9 patients declined lead extraction because of prohibitive operative risk, and 6 patients had questionable indications for extraction. The remaining 65 patients with pocket infection, who were eligible for extraction, but opted for CITA treatment, were compared with 81 patients with pocket infection and similar characteristics who underwent device/lead extraction as primary therapy. Results: A total of 80 patients with pocket infection were treated with CITA during 2007-2021. CITA was curative in 85% (n = 68 of 80) of patients, who remained free of infection (median follow-up 3 years [IQR: 1.0-6.8 years]). In the case-control study of CITA vs device/lead extraction, cure rates were higher after device/lead extraction than after CITA (96.2% [n = 78 of 81] vs 84.6% [n = 55 of 65]; P = 0.027). However, rates of serious complications were also higher after extraction (n = 12 [14.8%] vs n = 1 [1.5%]; P = 0.005). All-cause 1-month and 1-year mortality were similar for CITA and device/lead extraction (0.0% vs 3.7%; P = 0.25 and 12.3% vs 13.6%; P = 1.00, respectively). Extraction was avoided in 90.8% (n = 59 of 65) of extraction-eligible patients treated with CITA. Conclusions: CITA is a safe and effective alternative for patients with pocket infection who are unsuitable or unwilling to undergo extraction.
KW - defibrillator
KW - infection
KW - lead extraction
KW - pacemaker
UR - http://www.scopus.com/inward/record.url?scp=85144748258&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2022.10.022
DO - 10.1016/j.jacc.2022.10.022
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AN - SCOPUS:85144748258
SN - 0735-1097
VL - 81
SP - 119
EP - 133
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 2
ER -