Optimizing Management of Cardiac Implantable Electronic Device Infections: Insights from a Prospective Registry

Objectives: To evaluate risk factors, management strategies, and clinical outcomes in patients with cardiac implantable electronic device (CIED) infections, with a focus on optimizing treatment pathways and reducing reinfection rates. Methods: This prospective observational registry included 100 patients with confirmed CIED infections managed at the National Heart Institute, Egypt, between December 2021 and April 2023. Patients were categorized based on whether inpatient empirical intravenous antibiotics were administered prior to device extraction. Data collected included demographics, clinical characteristics, microbiological findings, management approaches, and outcomes. The primary outcomes were infection resolution and reinfection within six months, while secondary outcomes included hospital stay, antibiotic duration, rehospitalization, and mortality. Results: Early infections (<1 year) accounted for 45% of cases, while delayed infections (>1 year) comprised 55%. Culture positivity was observed in 40% of patients, predominantly due to coagulase-negative staphylococci (32.5%). The median time from diagnosis to device extraction was 2 weeks (IQR 2–3). Patients managed without inpatient empirical intravenous antibiotics prior to extraction had significantly shorter hospital stays (median 4 [3–4] weeks vs. 6 [4–6] weeks, P = 0.005), while antibiotic duration before and after device removal did not differ significantly (P = 0.059 for both). Re-implantation was performed in 82% of patients. No in-hospital mortality occurred, and reinfection was observed in 2% during six-month follow-up. Conclusions: In this prospective registry, a selected management pathway involving omission of inpatient empirical intravenous antibiotics prior to extraction in carefully chosen patients was associated with shorter hospital stay without compromising infection control. However, given the observational design and baseline differences between groups, these findings should be interpreted as associative rather than causal and warrant further investigation in controlled studies.