title: Infection control in implantation of cardiac implantable electronic devices: current evidence, controversial points, and unresolved issues.
abstract: A significant increase in the implantation of cardiac implantable electronic devices (CIEDs) is evident over the past years, while there is evidence for a disproportionate increase in CIED-related infections. The cumulative probability of device infection seems to be higher in implantable cardioverter defibrillator and in cardiac resynchronization therapy patients compared with permanent pacemaker patients. Given that more than a half of CIED infections are possibly related to the operative procedure, there is a need for effective periprocedural infection control. However, many of the current recommendations are empirical and not evidence-based, while questions, unresolved issues, and conflicting evidence arise. The perioperative systemic use of antibiotics confers significant benefit in prevention of CIED infections. However, there are no conclusive data regarding the specific value of each agent in different clinical settings, the value of post-operative antibiotic treatment as well as the optimal duration of therapy. The merit of local pocket irrigation with antibiotic and/or antiseptic agents remains unproved. Of note, recent evidence indicates that the application of antibacterial envelopes into the device pocket markedly decreases the infection risk. In addition, limited reports on strict integrated infection control protocols show a dramatic reduction in infection rates in this setting and therefore deserve further attention. Finally, the relative impact of particular factors on the infection risk, including the type of the CIED, patients' individual characteristics and comorbidities, should be further examined since it may facilitate the development of tailored prophylactic interventions for each patient.
authors.affiliation: First Department of Cardiology, University of Ioannina Medical School, Ioannina 45110, Greece p.korantzopoulos@yahoo.gr pkorantz@cc.uoi.gr.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Korantzopoulos
authors.affiliation: State Cardiology Department, Hippokration Hospital, Athens, Greece.
authors.forename: Skevos
authors.initials: S
authors.lastname: Sideris
authors.affiliation: First Cardiology Division, University of Athens School of Medicine, Athens, Greece.
authors.forename: Polychronis
authors.initials: P
authors.lastname: Dilaveris
authors.affiliation: First Cardiology Division, University of Athens School of Medicine, Athens, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Gatzoulis
authors.affiliation: First Department of Cardiology, University of Ioannina Medical School, Ioannina 45110, Greece.
authors.forename: John A
authors.initials: JA
authors.lastname: Goudevenos
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D004334:Drug Administration Schedule; D006801:Humans; D017053:Infection Control / Q000379:methods*; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000382:microbiology / Q000517:prevention & control*; D007507:Therapeutic Irrigation; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Arrhythmia devices; Complications; Implantable cardioverter-defibrillators; Infection; Pacemakers; Prevention