title: The role of prophylaxis topical antibiotics in cardiac device implantation.
abstract: BACKGROUND
  Combined systemic and topical antibiotic prophylaxes are used in cardiac electronic implantable device (CEID) procedures, but very few studies have assessed prophylactic use of topical antibiotics after CEID implantation.
  
  
  OBJECTIVE
  To evaluate the efficacy of topical antibiotic prophylaxis in the prevention of surgical site infection after CEID implantation procedures.
  
  
  METHODS
  This was a prospective randomized, placebo-controlled, single-center, single-operator study. All patients (n = 1,008) received standard systemic antibiotic prophylaxis. Patients were randomized into four groups and received various topical prophylaxes after procedure. All patients were followed for at least 12 months. Surgical site inflammation and infection were graded based on degree of inflammation, discharge, wound culture, and blood culture.
  
  
  RESULTS
  Fifty-eight patients developed surgical site inflammation and infection. Fourteen patients had culture-positive wound infections. Among them, 13 patients had superficial wound infections with Staphylococcus species. Only one had pocket infection with Pseudomonas bacteremia. The surgical site infection rate was higher in those with longer procedural time, associated with 2.3 times more likelihood of infection (P = 0.01). Patients with an associated malignancy were associated with 3.6 times more likelihood of infection (P < 0.01).
  
  
  CONCLUSIONS
  Careful skin preparation prior to incision is important, whereas the use of topical antibiotics after closure has not shown significant benefit. Patients with malignancy and longer procedural times are more likely to develop infection. There is a trend for less infection with cephalic approach. Systemic antibiotics with staphylococcal coverage are needed as most of the wound culture positive infections are caused by Staphylococcus species.
authors.affiliation: Department of Electrophysiology, Easton Cardiovascular Associates, Easton, Pennsylvania.
authors.forename: Koroush
authors.initials: K
authors.lastname: Khalighi
authors.forename: Thein Tun
authors.initials: TT
authors.lastname: Aung
authors.forename: Farhad
authors.initials: F
authors.lastname: Elmi
mesh_terms: D000287:Administration, Topical; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001424:Bacterial Infections / Q000209:etiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D015990:Placebo Effect; D011292:Premedication / Q000379:methods*; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000517:prevention & control*; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents
keywords: ICD; cardiac electronic implantable devices; implantable defibrillator; implantation; infection; permanent pacemaker; topical prophylaxis