The following is a summary of “Regional Antibiotic Delivery for Implanted Cardiovascular Electronic Device Infections,” published in the January 2023 issue of Cardiology by Topaz, et al.

For both systemic infections and localized pocket infections, current recommendations recommend the total removal of all cardiovascular implanted electronic devices (pacemakers/defibrillators), including extraction of all intracardiac electrodes. The effectiveness of avoiding the need for device/lead extraction by continuously infusing an ultrahigh concentration of antibiotics (CITA) into the infected subcutaneous device pocket was assessed by researchers for a study.

About 80 individuals with pocket infections who received CITA treatment between 2007 and 2021 made up the CITA group. Nine of them refused lead extraction due to the prohibitive operational risk, and six presented dubious extraction indications. The 81 patients with pocket infection and comparable features who had device/lead extraction as primary therapy were compared to the remaining 65 patients with pocket infection who were eligible for extraction but chose CITA treatment.

Between 2007 and 2021, CITA was used to treat 80 individuals with pocket infections. Around 85% (n = 68 of 80) of patients responded favorably to CITA and were infection-free (median follow-up 3 years [IQR: 1.0-6.8 years]). In the case-control research comparing device/lead extraction and CITA, cure rates were greater following device/lead extraction (96.2% [n = 78 of 81] vs. 84.6% [n = 55 of 65]; P = 0.027) than following CITA. As a result of extraction, rates of significant problems were considerably greater (n = 12 [14.8%] vs n = 1 [1.5%]; P = 0.005). Mortality from all causes within the first month and year was comparable between CITA and device/lead extraction (0.0% vs 3.7%; P = 0.25 & 12.3% vs 13.6%; P = 1.00, respectively). 90.8% (n = 59 of 65) of the extraction-eligible patients who received CITA did not undergo extraction. 

For patients with pocket infections who were unable or unable to undergo extraction, CITA provided a secure and reliable option.

Reference: jacc.org/doi/10.1016/j.jacc.2022.10.022