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A Novel Method to Determine the Longitudinal Antibacterial Activity of Drug-Eluting Materials
Published on: March 3, 2023
Regional Antibiotic Delivery for Implanted Cardiovascular Electronic Device Infections
Moris Topaz1, Ehud Chorin2, Arie Lorin Schwartz2
1Department of Cardiology, Sourasky Tel Aviv Medical Center, Tel Aviv, Israel; Emeritus Plastic Surgery Unit, Hillel Yaffe Medical Center, Hadera, Israel.
Continuous, in situ-targeted, ultrahigh concentration of antibiotics (CITA) offers a safe and effective alternative for treating pocket infections in patients with cardiovascular implantable electronic devices (pacemakers/defibrillators). This approach avoids device and lead extraction in many cases, reducing complications.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Device Technology
Background:
- Current guidelines recommend complete removal of cardiovascular implantable electronic devices (CIEDs) for localized pocket infections.
- Device and lead extraction is the standard treatment for CIED pocket infections.
Purpose of the Study:
- To evaluate the efficacy of continuous, in situ-targeted, ultrahigh concentration of antibiotics (CITA) for treating CIED pocket infections.
- To determine if CITA can obviate the need for device/lead extraction in patients with CIED pocket infections.
Main Methods:
- A total of 80 patients with CIED pocket infections were treated with CITA between 2007 and 2021.
- A case-control study compared CITA treatment with traditional device/lead extraction in 65 and 81 patients, respectively.
Main Results:
- CITA was curative in 85% of patients, with a median follow-up of 3 years.
- Device/lead extraction showed higher cure rates (96.2%) than CITA (84.6%), but with significantly more serious complications (14.8% vs 1.5%).
- All-cause mortality rates at 1 month and 1 year were similar between CITA and device/lead extraction groups.
Conclusions:
- CITA is a safe and effective alternative treatment for CIED pocket infections, particularly for patients unsuitable or unwilling to undergo extraction.
- CITA successfully avoided device/lead extraction in 90.8% of eligible patients.
- This localized antibiotic delivery method presents a viable option for salvaging infected CIEDs.
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