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Prolonged antibiotic therapy before lead extraction in cardiac implantable electronic device infections as a way for diminishing the rate of septic shock.
Session:
Sessão de Posters 16 - Arritmologia
Speaker:
Tatiana Pavlenko
Congress:
CPC 2024
Topic:
C. Arrhythmias and Device Therapy
Theme:
04. Arrhythmias, General
Subtheme:
04.6 Arrhythmias, General – Clinical
Session Type:
Cartazes
FP Number:
---
Authors:
Tatiana Pavlenko; , Bruno Valente; Helder Santos; Ana Lousinha; Pedro Cunha; Guilherme Portugal; Paulo Osorio; Maria Bongiorni
Abstract
<p>Background: Device-related infection is one of the most serious complications of cardiac implantable electronic devices (CIED) therapy with substantial clinical and economic burden. Complete CIED removal is recommended for all patients with confirmed CIED infection, but the optimal duration of antibiotic therapy (AT) before lead extraction (LE) is still debatable. The aim of this study was to estimate the impact of prolonged AT before LE regarding the rate of occurrence of septic shock.</p> <p>Methods: Consecutive cases of LE due to CIED infection at our centre from 2013 to 2022 were reviewed. Our approach assumed the duration of AT for a minimum of 2 weeks for patients with pocket infection (PI), and 4 weeks for endocarditis with the exception of non-response to the AT. LE were performed using the «Pisa technique» in all cases.</p> <p>Results: From a total of 256 LE, 202 (in 198 patients) were due to CIED infection. PI rate was 62,4%, endocarditis 24,7%, concomitant 12,9%. Systemic infection rate was 43,1%. The mean dwell time of the leads was 92,2±5,0 months. In cases of PI, the mean time of AT before LE was 21,7±1,0 days (n=124), whereas it was 31,6±1,7 days (n=76) in cases of endocarditis (p<0.05). In total, 60,4% of the patients had an identified microbiological agent: 41,6% before LE and an additional 18,8% after LE (figure 1). The duration of AT after LE was 17,7±0,8 days (n=121) in cases of PI and 22,7±1,4 days (n=76) in cases of endocarditis (p<0.05). Procedural success was achieved in 98,5% and the procedural failure rate was 1,5% (figure 2). Complication rate was 2,5% for major and 8,9% for minor complications. There was no intraprocedural death. The number of septic shock episodes after LE was 3 cases (1,5%), all in systemic infection (2 with inadequate pre-procedural AT and 1 was non-responsive for AT before and after LE). Device re-implantation was performed in 68,8% with a mean time after LE of 43,7±12 days(n=138), the majority (57,6%) occurred within 7 days after LE. Total reinfection rate was 2% (4), 1,5% during the first year, all contralateral PI. Survival rate without reinfection was 94,1% and 80,2% at 1- and 12-month follow-up respectively. Mortality rate during the first 30 days was 5%.</p> <p>Conclusions: Appropriate prolonged AT before LE led to a very low risk of septic shock, low risk of reinfection and similar survival rate amongst patients with CIED-related infections in comparison to the guideline-recommended «extraction without delay» approach.</p>
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