title: Incidence of Pocket Infection Postcardiac Device Implantation Using Antibiotic versus Saline Solution for Pocket Irrigation.
abstract: BACKGROUND
  Preprocedure systemic antibiotic prophylaxis reduces infections in patients undergoing cardiac implantable electronic devices (CIEDs) implantations. Whether pocket irrigation with antibiotic solution offers any advantage over saline solution in CIED implantation is unknown.
  
  
  METHODS
  Records from 327 consecutive patients who underwent CIED implantation by three operators from February 2011 to January 2014 were reviewed. From February 2011 to January 2012, the antibiotic solution was used for pocket irrigation; from February 2012 to January 2014, saline solution was used. All patients received preprocedural IV antibiotics. Baseline demographics, comorbidities, lab data, and occurrence of any pocket infection postimplant were collected.
  
  
  RESULTS
  There were 118 and 209 patients in the antibiotic solution and saline solution group, respectively. A total of four (1.2%) patients had CIED infection: two in the antibiotic solution group and two in the saline solution group. Median time to infection from implant date was 81.5 ± 35 days. Two patients (50%) had infection after first device implantation. Of the four patients, one had positive blood culture, three had positive pocket cultures, one had lead vegetation, one underwent pocket exploration, and all of them had devices/leads extracted, with reimplantation on the contralateral side. No mortality was observed due to infectious complications.
  
  
  CONCLUSIONS
  When compared to pocket irrigation in the antibiotic solution group, the saline solution group was not associated with increased incidence of infectious complications after CIED implantation. The use of saline solution pocket irrigation alone may be used in CIED pocket irrigation periprocedurally.  Further evaluation in larger randomized trials is needed.
authors.affiliation: Department of Cardiology, Mayo Clinic, Rochester, Minnesota. drlumashankar@gmail.com.
authors.forename: Umashankar
authors.initials: U
authors.lastname: Lakshmanadoss
authors.affiliation: Oakland University William Beaumont School of Medicine, Rochester, Michigan.
authors.forename: Bonita
authors.initials: B
authors.lastname: Nuanez
authors.affiliation: Department of Cardiology, Beaumont Health, Royal Oak, Michigan.
authors.forename: Ilana
authors.initials: I
authors.lastname: Kutinsky
authors.affiliation: Department of Cardiology, University of Rochester Medical Center, Rochester, New York.
authors.forename: Rizwan
authors.initials: R
authors.lastname: Khalid
authors.affiliation: Department of Cardiology, Beaumont Health, Royal Oak, Michigan.
authors.forename: David E
authors.initials: DE
authors.lastname: Haines
authors.affiliation: Department of Cardiology, Beaumont Health, Royal Oak, Michigan.
authors.forename: Wai Shun
authors.initials: WS
authors.lastname: Wong
mesh_terms: D000368:Aged; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data*; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008824:Michigan / Q000453:epidemiology; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D019919:Prosthesis Implantation / Q000706:statistics & numerical data; D016459:Prosthesis-Related Infections / Q000453:epidemiology* / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors; D012965:Sodium Chloride / Q000627:therapeutic use; D007507:Therapeutic Irrigation / Q000706:statistics & numerical data*; D016896:Treatment Outcome
chemical_list: D012965:Sodium Chloride
keywords: antibiotic solution; cardiac device implantation; infection; saline irrigation