Login / Register Submit Your Article
cover
Article Menu
Journal Browser
Vol. 2 (2024)
Vol. 1 (2023)
Indexing and Partners

Google scholar

Crossref

Open Access Journal Article

Effectiveness of Postoperative Systemic Antibiotic Prophylaxis Following Cardiovascular Implantable Electronic Device Implantation: A Systematic Review and Meta-Analysis

by Hanaa Elshazly 1 orcid
1
Faculty of pharmacy, Beni-suef University, Beni-suef, Egypt
*
Author to whom correspondence should be addressed.
IJCMR  2024 2(5):36; https://doi.org/10.61466/ijcmr2050001
Received: 4 June 2024 / Accepted: 1 August 2024 / Published Online: 5 August 2024
View Full-Text
Download PDF

Abstract

Background

Cardiac implantable electronic devices (CIED) represent established life-sustaining interventions for various cardiac conditions, but post-placement infections are associated with high morbidity and mortality. Although pre-procedural antibiotic prophylaxis effectively reduces CIED infection rates, limited data exist on post-procedural antibiotic use, especially beyond 24 hours. This study assesses the efficacy of post-procedural antibiotic usage in preventing CIED placement-related infections.

Methods

We conducted a systematic review and meta-analysis, including studies that examined the comparative outcomes among patients. The study cohorts were divided into two groups: (1) those who underwent preoperative antibiotic prophylaxis followed by a continuation of 24 hours or more postoperatively (intervention group); and (2) those who received either preoperative-only antibiotic prophylaxis or preoperative prophylaxis with a duration of less than 24 hours postoperatively (control group). Risk of bias was assessed with ROBINS-I and ROB-2 tools. Risk ratio (RR) was pooled using random-effect or fixed-effect meta-analyses with inverse variance method.

Results

Our analysis of ten studies, including four randomized controlled trials and six cohort studies with 27,375 participants, revealed no statistically significant differences in outcomes between two groups. These outcomes included (CIED) infection rates (RR 0.83, 95% CI 0.47, 1.44), mortality (RR 1.22, 95% CI 0.66, 2.25), pocket hematoma (RR 1.01, 95% CI 0.54, 1.92) and re-intervention (RR 0.71, 95% CI 0.20, 2.50). The larger randomized controlled trial had an obvious impact on the overall findings.

Conclusions

The present systematic review and meta-analysis found no advantage in extending postoperative antibiotic prophylaxis for more than 24 hours following (CIED) implantation. These findings align with prevailing guidelines which support antibiotic stewardship practices. This approach has the ability to reduce adverse drug events, curb the potential for antibiotic resistance and alleviate the financial burdens associated with prolonged postoperative antibiotic prophylaxis.

Keywords: infection; post-operative; antibiotic; cardiovascular;
Copyright: © 2024 by Elshazly. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) (Creative Commons Attribution 4.0 International License). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

Share and Cite

ACS Style
Elshazly, H. Effectiveness of Postoperative Systemic Antibiotic Prophylaxis Following Cardiovascular Implantable Electronic Device Implantation: A Systematic Review and Meta-Analysis. International Journal of Clinical Medical Research, 2024, 2, 36. https://doi.org/10.61466/ijcmr2050001
AMA Style
Elshazly H. Effectiveness of Postoperative Systemic Antibiotic Prophylaxis Following Cardiovascular Implantable Electronic Device Implantation: A Systematic Review and Meta-Analysis. International Journal of Clinical Medical Research; 2024, 2(5):36. https://doi.org/10.61466/ijcmr2050001
Chicago/Turabian Style
Elshazly, Hanaa 2024. "Effectiveness of Postoperative Systemic Antibiotic Prophylaxis Following Cardiovascular Implantable Electronic Device Implantation: A Systematic Review and Meta-Analysis" International Journal of Clinical Medical Research 2, no.5:36. https://doi.org/10.61466/ijcmr2050001
APA style
Elshazly, H. (2024). Effectiveness of Postoperative Systemic Antibiotic Prophylaxis Following Cardiovascular Implantable Electronic Device Implantation: A Systematic Review and Meta-Analysis. International Journal of Clinical Medical Research, 2(5), 36. https://doi.org/10.61466/ijcmr2050001

Article Metrics

Article Access Statistics

References

  1. Baddour, L.M., A.E. Epstein, C.C. Erickson, B.P. Knight, M.E. Levison, P.B. Lockhart, F.A. Masoudi, E.J. Okum, W.R. Wilson, and L.B. Beerman, Update on cardiovascular implantable electronic device infections and their management: a scientific statement from the American Heart Association. Circulation, 2010. 121(3): p. 458-477.
  2. Mahtani, K., E. Maclean, and R. Schilling, Prevention and management of cardiac implantable electronic device infections: state-of-the-art and future directions. Heart, Lung and Circulation, 2022.
  3. Greenspon, A.J., J.D. Patel, E. Lau, J.A. Ochoa, D.R. Frisch, R.T. Ho, B.B. Pavri, and S.M. Kurtz, 16-year trends in the infection burden for pacemakers and implantable cardioverter-defibrillators in the United States: 1993 to 2008. Journal of the American College of Cardiology, 2011. 58(10): p. 1001-1006.
  4. Tarakji, K.G., E.J. Chan, D.J. Cantillon, A.L. Doonan, T. Hu, S. Schmitt, T.G. Fraser, A. Kim, S.M. Gordon, and B.L. Wilkoff, Cardiac implantable electronic device infections: presentation, management, and patient outcomes. Heart rhythm, 2010. 7(8): p. 1043-1047.
  5. Greenspon, A.J., J.M. Prutkin, M.R. Sohail, H.R. Vikram, L.M. Baddour, S.B. Danik, J. Peacock, C. Falces, J.M. Miro, and E. Blank, Timing of the most recent device procedure influences the clinical outcome of lead-associated endocarditis: results of the MEDIC (Multicenter Electrophysiologic Device Infection Cohort). Journal of the American College of Cardiology, 2012. 59(7): p. 681-687.
  6. Hussein, A.A., Y. Baghdy, O.M. Wazni, M.P. Brunner, G. Kabbach, M. Shao, S. Gordon, W.I. Saliba, B.L. Wilkoff, and K.G. Tarakji, Microbiology of cardiac implantable electronic device infections. JACC: Clinical Electrophysiology, 2016. 2(4): p. 498-505.
  7. Walter, P., H. Scheld, and W. Brade, Reduction of the infection rate following pacemaker implantation through the perioperative administration of cephalothin. Die Medizinische Welt, 1978. 29(18): p. 736-739.
  8. Asundi, A., M. Stanislawski, P. Mehta, A.E. Baron, H.J. Mull, P.M. Ho, P.J. Zimetbaum, K. Gupta, and W. Branch-Elliman, Real-world effectiveness of infection prevention interventions for reducing procedure-related cardiac device infections: Insights from the veterans affairs clinical assessment reporting and tracking program. Infection Control & Hospital Epidemiology, 2019. 40(8): p. 855-862.
  9. Da Costa, A., G. Kirkorian, M. Cucherat, F.o. Delahaye, P. Chevalier, A. Cerisier, K. Isaaz, and P. Touboul, Antibiotic prophylaxis for permanent pacemaker implantation: a meta-analysis. Circulation, 1998. 97(18): p. 1796-1801.
  10. de Oliveira, J.C., M. Martinelli, S.A.D.O. Nishioka, T.n. Varejão, D. Uipe, A.s.A.A. Pedrosa, R. Costa, and S.B. Danik, Efficacy of antibiotic prophylaxis before the implantation of pacemakers and cardioverter-defibrillators: results of a large, prospective, randomized, double-blinded, placebo-controlled trial. Circulation: Arrhythmia and Electrophysiology, 2009. 2(1): p. 29-34.
  11. Sandoe, J.A., G. Barlow, J.B. Chambers, M. Gammage, A. Guleri, P. Howard, E. Olson, J.D. Perry, B.D. Prendergast, and M.J. Spry, Guidelines for the diagnosis, prevention and management of implantable cardiac electronic device infection. Report of a joint Working Party project on behalf of the British Society for Antimicrobial Chemotherapy (BSAC, host organization), British Heart Rhythm Society (BHRS), British Cardiovascular Society (BCS), British Heart Valve Society (BHVS) and British Society fo
  12. Vo, H., D. Scott, J. Coromilas, and J. Kassotis, A Survey of Antibiotic Use During Insertion of Cardiovascular Implantable Devices Amongst US Implanters. Circulation, 2019. 140(Suppl_1): p. A14048-A14048.
  13. Zheng, Q., L. Di Biase, K.J. Ferrick, J.N. Gross, N.A. Guttenplan, S.G. Kim, A.K. Krumerman, E.C. Palma, and J.D. Fisher, Use of antimicrobial agent pocket irrigation for cardiovascular implantable electronic device infection prophylaxis: results from an international survey. Pacing and Clinical Electrophysiology, 2018. 41(10): p. 1298-1306.
  14. DeSimone, D.C., A.A. Chahal, C.V. DeSimone, S.J. Asirvatham, P.A. Friedman, L.M. Baddour, and M.R. Sohail, International survey of knowledge, attitudes, and practices of cardiologists regarding prevention and management of cardiac implantable electronic device infections. Pacing and Clinical Electrophysiology, 2017. 40(11): p. 1260-1268.
  15. Chiang, K.-H., T.-F. Chao, W.-S. Lee, Y.-J. Lin, T.-C. Tuan, and C.-W. Kong, How long should prophylactic antibiotics be prescribed for permanent pacemaker implantations? One day versus three days. Acta Cardiologica Sinica, 2013. 29(4): p. 341.
  16. Kabulski, G.M., A. Northup, and B.S. Wiggins, Postoperative antibiotic prophylaxis following cardiac implantable electronic device placement. The Journal of Innovations in Cardiac Rhythm Management, 2019. 10(8): p. 3777.
  17. Lee, W.H., T.C. Huang, L.J. Lin, P.T. Lee, C.C. Lin, C.H. Lee, T.H. Chao, Y.H. Li, and J.Y. Chen, Efficacy of postoperative prophylactic antibiotics in reducing permanent pacemaker infections. Clinical cardiology, 2017. 40(8): p. 559-565.
  18. Malagù, M., F. Vitali, A. Brieda, P. Cimaglia, M. De Raffele, E. Tazzari, C. Musolino, C. Balla, M. Serenelli, and R. Cultrera, Antibiotic prophylaxis based on individual infective risk stratification in cardiac implantable electronic device: the PRACTICE study. EP Europace, 2022. 24(3): p. 413-420.
  19. Senaratne, J.M., A. Jayasuriya, M. Irwin, S. Gulamhusein, and M.P. Senaratne, A 19‐year study on pacemaker‐related infections: A claim for using postoperative antibiotics. Pacing and Clinical Electrophysiology, 2014. 37(8): p. 947-954.
  20. Uslan, D.Z., M.J. Gleva, D.K. Warren, T. Mela, M.K. Chung, V. Gottipaty, R. Borge, D. Dan, T. Shinn, and K. Mitchell, Cardiovascular implantable electronic device replacement infections and prevention: results from the REPLACE Registry. Pacing and clinical electrophysiology, 2012. 35(1): p. 81-87.
  21. Krahn, A.D., Y. Longtin, F. Philippon, D.H. Birnie, J. Manlucu, P. Angaran, C. Rinne, B. Coutu, R.A. Low, and V. Essebag, Prevention of arrhythmia device infection trial: the PADIT trial. Journal of the American College of Cardiology, 2018. 72(24): p. 3098-3109.
  22. Dwivedi, S.K., R.K. Saran, P. Khera, N. Tripathi, A.K. Kochar, V.S. Narain, and V.K. Puri, Short-term (48 hours) versus long-term (7 days) antibiotic prophylaxis for permanent pacemaker implantation. Indian heart journal, 2001. 53(6): p. 740-742.
  23. Madadi, S., M. Kafi, J. Kheirkhah, A. Azhari, M. Kiarsi, A. Mehryar, A. Fazelifar, A. Alizadehdiz, Z. Emkanjoo, and M. Haghjoo, Postoperative antibiotic prophylaxis in the prevention of cardiac implantable electronic device infection. Pacing and Clinical Electrophysiology, 2019. 42(2): p. 161-165.
  24. Ellis, C.R., A.J. Greenspon, J.A. Andriulli, P.A. Gould, R.G. Carillo, M.J. Kolek, R. Donegan, A.P. Amaral, and S. Mittal, Randomized Trial of Stand-Alone Use of the Antimicrobial Envelope in High-Risk Cardiac Device Patients. Circulation: Arrhythmia and Electrophysiology, 2023. 16(5): p. e011740.
  25. Dwivedi, S., R. Saran, P. Khera, N. Tripathi, A. Kochar, V. Narain, and V. Puri, Short-term (48 hours) versus long-term (7 days) antibiotic prophylaxis for permanent pacemaker implantation. Indian Heart Journal, 2001. 53(6): p. 740-742.
  26. Xiang, K., J.N. Catanzaro, C. Elayi, Z.E. Garrigos, M.R. Sohail, Z.E. Garrigos, and M.R. Sohail, Antibiotic-eluting envelopes to prevent cardiac-implantable electronic device infection: past, present, and future. Cureus, 2021. 13(2).
  27. Khalighi, K., T.T. Aung, and F. Elmi, The role of prophylaxis topical antibiotics in cardiac device implantation. Pacing and clinical electrophysiology, 2014. 37(3): p. 304-311.
  28. Tascini, C., A. Antonelli, M. Pini, S. De Vivo, N. Aiezza, M. Bernardo, M. Di Luca, and G.M. Rossolini, Infective Endocarditis Associated with Implantable Cardiac Device by Metallo-β-Lactamase-Producing Pseudomonas aeruginosa, Successfully Treated with Source Control and Cefiderocol Plus Imipenem. Antimicrobial Agents and Chemotherapy, 2023. 67(3): p. e01313-22.
  29. McDonald, M., E. Grabsch, C. Marshall, and A. Forbes, SINGLE‐VERSUS MULTIPLE–DOSE antimicrobial prophylaxis for major surgery: a systematic review. Australian and New Zealand Journal of Surgery, 1998. 68(6): p. 388-395.
  30. Tarakji, K.G., S. Mittal, C. Kennergren, R. Corey, J.E. Poole, E. Schloss, J. Gallastegui, R.A. Pickett, R. Evonich, and F. Philippon, Antibacterial envelope to prevent cardiac implantable device infection. New England Journal of Medicine, 2019. 380(20): p. 1895-1905.
  31. Le, K.Y., M.R. Sohail, P.A. Friedman, D.Z. Uslan, S.S. Cha, D.L. Hayes, W.R. Wilson, J.M. Steckelberg, L.M. Baddour, and M.C.I.S. Group, Impact of timing of device removal on mortality in patients with cardiovascular implantable electronic device infections. Heart Rhythm, 2011. 8(11): p. 1678-1685.
  32. Chaudhry, U., R. Borgquist, J.G. Smith, and D. Mörtsell, Efficacy of the antibacterial envelope to prevent cardiac implantable electronic device infection in a high-risk population. EP Europace, 2022. 24(12): p. 1973-1980.
  33. Le, K.Y., M.R. Sohail, P.A. Friedman, D.Z. Uslan, S.S. Cha, D.L. Hayes, W.R. Wilson, J.M. Steckelberg, L.M. Baddour, and M.C.I.S. Group, Clinical features and outcomes of cardiovascular implantable electronic device infections due to staphylococcal species. The American journal of cardiology, 2012. 110(8): p. 1143-1149.
  34. Narducci, M.L., G. Pelargonio, E. Russo, L. Marinaccio, A. Di Monaco, F. Perna, G. Bencardino, M. Casella, L. Di Biase, and P. Santangeli, Usefulness of intracardiac echocardiography for the diagnosis of cardiovascular implantable electronic device–related endocarditis. Journal of the American College of Cardiology, 2013. 61(13): p. 1398-1405.
  35. Traykov, V., M.G. Bongiorni, G. Boriani, H. Burri, R. Costa, N. Dagres, J.-C. Deharo, L.M. Epstein, P.A. Erba, U. Snygg-Martin, J.C. Nielsen, J.E. Poole, L. Saghy, C. Starck, N. Strathmore, and C. Blomström-Lundqvist, Clinical practice and implementation of guidelines for the prevention, diagnosis and management of cardiac implantable electronic device infections: results of a worldwide survey under the auspices of the European Heart Rhythm Association. EP Europace, 2019. 21(8): p. 1270-1279.
  36. Viganego, F., S. O'Donoghue, Z. Eldadah, M.H. Shah, M. Rastogi, J.A. Mazel, and E.V. Platia, Effect of early diagnosis and treatment with percutaneous lead extraction on survival in patients with cardiac device infections. The American journal of cardiology, 2012. 109(10): p. 1466-1471.
  37. Berríos-Torres, S.I., C.A. Umscheid, D.W. Bratzler, B. Leas, E.C. Stone, R.R. Kelz, C.E. Reinke, S. Morgan, J.S. Solomkin, and J.E. Mazuski, Centers for disease control and prevention guideline for the prevention of surgical site infection, 2017. JAMA surgery, 2017. 152(8): p. 784-791.
  38. Basil, A., S.A. Lubitz, P.A. Noseworthy, M.R. Reynolds, H. Gold, D. Yassa, and D. Kramer, Periprocedural antibiotic prophylaxis for cardiac implantable electrical device procedures: results from a Heart Rhythm Society survey. JACC: Clinical Electrophysiology, 2017. 3(6): p. 632-634.
  39. Birnie, D.H., J. Wang, M. Alings, F. Philippon, R. Parkash, J. Manlucu, P. Angaran, C. Rinne, B. Coutu, and R.A. Low, Risk factors for infections involving cardiac implanted electronic devices. Journal of the American College of Cardiology, 2019. 74(23): p. 2845-2854.
  40. Senaratne, J.M., J. Wijesundera, U. Chhetri, D. Beaudette, A. Sander, M. Hanninen, S. Gulamhusein, and M. Senaratne, Reduced incidence of CIED infections with peri-and post-operative antibiotic use in CRT-P/D and ICD procedures. Medicine, 2022. 101(40).
  41. Kranick, S., N. Mishra, A. Theertham, H. Vo, E. Hiltner, J. Coromilas, and J. Kassotis, A Survey of Antibiotic Use During Insertion of Cardiovascular Implantable Devices Among United States Implanters. Angiology, 2023. 74(4): p. 351-356.
  42. De Jonge, S.W., S.L. Gans, J.J. Atema, J.S. Solomkin, P.E. Dellinger, and M.A. Boermeester, Timing of preoperative antibiotic prophylaxis in 54,552 patients and the risk of surgical site infection: A systematic review and meta-analysis. Medicine, 2017. 96(29).
  43. DiPiro, J.T., J.J. Vallner, T.A. Bowden, B.A. Clark, and J.F. Sisley, Intraoperative serum and tissue activity of cefazolin and cefoxitin. Archives of Surgery, 1985. 120(7): p. 829-832.
  44. Traykov, V., K. Dzhinsov, and P.T. Matusik, Infections of cardiac implantable electronic devices: epidemiology, mechanisms and preventive measures. Kardiologia Polska (Polish Heart Journal), 2023.