Lakshmanadoss Umashankar, Nuanez Bonita, Kutinsky Ilana, Khalid Rizwan, Haines David E, Wong Wai Shun
Department of Cardiology, Mayo Clinic, Rochester, Minnesota.
Oakland University William Beaumont School of Medicine, Rochester, Michigan.
Pacing Clin Electrophysiol. 2016 Sep;39(9):978-84. doi: 10.1111/pace.12920. Epub 2016 Aug 18.
Preprocedure systemic antibiotic prophylaxis reduces infections in patients undergoing cardiac implantable electronic devices (CIEDs) implantations. Whether pocket irrigation with antibiotic solution offers any advantage over saline solution in CIED implantation is unknown.
Records from 327 consecutive patients who underwent CIED implantation by three operators from February 2011 to January 2014 were reviewed. From February 2011 to January 2012, the antibiotic solution was used for pocket irrigation; from February 2012 to January 2014, saline solution was used. All patients received preprocedural IV antibiotics. Baseline demographics, comorbidities, lab data, and occurrence of any pocket infection postimplant were collected.
There were 118 and 209 patients in the antibiotic solution and saline solution group, respectively. A total of four (1.2%) patients had CIED infection: two in the antibiotic solution group and two in the saline solution group. Median time to infection from implant date was 81.5 ± 35 days. Two patients (50%) had infection after first device implantation. Of the four patients, one had positive blood culture, three had positive pocket cultures, one had lead vegetation, one underwent pocket exploration, and all of them had devices/leads extracted, with reimplantation on the contralateral side. No mortality was observed due to infectious complications.
When compared to pocket irrigation in the antibiotic solution group, the saline solution group was not associated with increased incidence of infectious complications after CIED implantation. The use of saline solution pocket irrigation alone may be used in CIED pocket irrigation periprocedurally. Further evaluation in larger randomized trials is needed.
术前全身应用抗生素预防可降低接受心脏植入式电子设备（CIED）植入术患者的感染率。在CIED植入术中，用抗生素溶液进行囊袋冲洗是否比用生理盐水溶液更具优势尚不清楚。
回顾了2011年2月至2014年1月由三名操作者连续进行CIED植入术的327例患者的记录。2011年2月至2012年1月，使用抗生素溶液进行囊袋冲洗；2012年2月至2014年1月，使用生理盐水溶液。所有患者术前均接受静脉注射抗生素。收集患者的基线人口统计学资料、合并症、实验室数据以及植入后任何囊袋感染的发生情况。
抗生素溶液组和生理盐水溶液组分别有118例和209例患者。共有4例（1.2%）患者发生CIED感染：抗生素溶液组2例，生理盐水溶液组2例。从植入日期到感染的中位时间为81.5±35天。2例患者（50%）在首次植入设备后发生感染。4例患者中，1例血培养阳性，3例囊袋培养阳性，1例有导线赘生物，1例接受了囊袋探查，所有患者均取出了设备/导线，并在对侧重新植入。未观察到因感染并发症导致的死亡。
与抗生素溶液组的囊袋冲洗相比，生理盐水溶液组在CIED植入术后感染并发症的发生率并未增加。在CIED囊袋冲洗术中，可单独使用生理盐水溶液进行囊袋冲洗。需要在更大规模的随机试验中进行进一步评估。
