Regional antibiotic delivery a viable option for patients with device implant infections

Delivery of continuous, in situ–targeted, ultrahigh concentration of antibiotics (CITA) is a safe and effective therapy for patients with pocket infection who are neither suited nor willing to undergo extraction of implanted cardiovascular electronic device, reports a study.

Eighty patients with pocket infection were treated with CITA from 2007 to 2021, of which nine declined lead extraction due to prohibitive operative risk, and six had questionable indications for extraction. The remaining 65 patients, who were eligible for extraction but opted for CITA treatment, were compared with 81 patients with similar characteristics who underwent device/lead extraction as primary therapy.

CITA was effective in 68 of 80 (85 percent) patients who remained free of infection (median follow-up 3 years). Cure rates in the case-control study of CITA versus device/lead extraction were higher after extraction than after CITA (96.2 percent vs 84.6 percent; p=0.027). However, the rates of serious complications were also higher in the extraction group (14.8 percent vs 1.5 percent; p=0.005).

All-cause mortality rates at 1 month (0.0 percent vs 3.7 percent; p=0.25) and 1 year (12.3 percent vs 13.6 percent; p=1.00) were similar between CITA and device/lead extraction cohorts. Of note, extraction was avoided in 59 of 65 (90.8 percent) of extraction-eligible patients treated with CITA.

“Present guidelines endorse complete removal of cardiovascular implantable electronic devices (pacemakers/defibrillators), including extraction of all intracardiac electrodes, not only for systemic infections, but also for localized pocket infections,” the authors said.