Postoperative antibiotic prophylaxis following cardiac implantable electronic device implantation was not associated with a significant difference in definite infection rates compared to no prophylaxis (0.5% vs 0%, p=0.82).
Cohort (n=200)
No
Does postoperative antibiotic prophylaxis reduce CIED-related infections in adults undergoing CIED implantation?
Postoperative antibiotic prophylaxis following CIED implantation was not associated with a detectable reduction in infection rates, supporting current guidelines that advise against routine postoperative use.
Absolute Event Rate: 0.5% vs 0%
p-value: p=0.82
BACKGROUND: Cardiac implantable electronic devices (CIEDs) manage arrhythmias and prevent sudden cardiac death, but related infections are rising. Pre-implantation antibiotics lower infection rates, while postoperative use is debated. PURPOSE: To evaluate current postoperative prophylactic antibiotic practices and CIED infection rates. METHOD: A retrospective cohort study at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia, included adults > 18 who underwent CIED implantation from 2017 to 2022. The primary outcome measured infection rates post-antibiotic prophylaxis. Data were analyzed using Stata 18.5. RESULTS: The study included 200 patients, predominantly male (62%), with a median age of 64 years. Common comorbidities included hypertension (71.5%), diabetes (65.5%), and heart failure (64%). All patients received pre-operative antibiotics, primarily cefazolin (88.4%) and vancomycin (6.5%). Most patients (95%) received postoperative antibiotics, most commonly amoxicillin/clavulanic acid (83.6%), while 14% received combination therapy. Among patients who received postoperative antibiotics (n = 190), 1 definite infection (0.5%) and 3 possible infections (1.5%) were observed, with no infections identified among those who did not receive postoperative antibiotics (n = 10). Regarding duration, possible infections occurred in 1.0% of patients receiving antibiotics for more than 7 days and 2.3% of those receiving 7 days or less. In the regimen analysis, definite infection occurred in 0.6% of patients receiving single-agent therapy and none in those receiving combination therapy. Given the low number of events, these findings are descriptive and should be interpreted as exploratory. CONCLUSION: Prophylactic antibiotics for 7 days or less, or a single agent, was not associated with a detectable difference in infection rates. A larger prospective study including patients not receiving prophylactic antibiotics post-implantation is needed to distinguish infection rates between those who did and did not receive them. CLINICAL TRIAL NUMBER: Not applicable.
Aljohani et al. (Fri,) conducted a cohort in Cardiac implantable electronic device (CIED) implantation (n=200). Postoperative antibiotic prophylaxis vs. No postoperative antibiotic prophylaxis was evaluated on Definite CIED-related infection (p=0.82). Postoperative antibiotic prophylaxis following cardiac implantable electronic device implantation was not associated with a significant difference in definite infection rates compared to no prophylaxis (0.5% vs 0%, p=0.82).