Rethinking Antibiotic Prophylaxis in Femoral-Access Catheter Ablation: A Pragmatic, Risk-Based Proposal

Area of Science:

• Cardiology
• Infectious Diseases
• Clinical Practice Guidelines

Background:

• Current international guidelines lack specific recommendations for antibiotic prophylaxis in femoral-access catheter ablation procedures.
• Infectious complications, though rare, can be severe, leading to significant morbidity and mortality.
• Growing concerns about antimicrobial resistance necessitate a more selective approach to antibiotic prophylaxis.

Purpose of the Study:

• To review evidence on infectious complications associated with femoral-access catheter ablation and electrophysiological studies.
• To inform clinical decision-making in the absence of prospective data by integrating indirect evidence and biological plausibility.
• To propose a pragmatic, risk-based institutional protocol for antibiotic prophylaxis.

Main Methods:

• Narrative review of existing literature on infectious complications in femoral-access procedures.
• Integration of indirect evidence and biological plausibility for clinical decision support.
• Development of a risk-based protocol through multidisciplinary collaboration.

Main Results:

• Identified variability in current practice regarding antibiotic prophylaxis for catheter ablation.
• Proposed a risk-based protocol that discourages routine prophylaxis in low-risk patients.
• Advocated for selective antibiotic use in predefined high-risk scenarios.

Conclusions:

• A risk-based approach to antibiotic prophylaxis in catheter ablation can enhance patient safety.
• Selective antibiotic use supports antimicrobial stewardship and combats resistance.
• The proposed framework aims to reduce practice variability in electrophysiology.