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The Role of Prophylaxis Topical Antibiotics in Cardiac Device Implantation
Author(s) -
KHALIGHI KOROUSH,
AUNG THEIN TUN,
ELMI FARHAD
Publication year - 2014
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.12280
Subject(s) - medicine , antibiotics , antibiotic prophylaxis , bacteremia , surgery , surgical wound , sepsis , randomized controlled trial , malignancy , placebo , systemic antibiotics , pathology , microbiology and biotechnology , biology , alternative medicine
Background Combined systemic and topical antibiotic prophylaxes are used in cardiac electronic implantable device (CEID) procedures, but very few studies have assessed prophylactic use of topical antibiotics after CEID implantation. Objective To evaluate the efficacy of topical antibiotic prophylaxis in the prevention of surgical site infection after CEID implantation procedures. Methods This was a prospective randomized, placebo‐controlled, single‐center, single‐operator study. All patients (n = 1,008) received standard systemic antibiotic prophylaxis. Patients were randomized into four groups and received various topical prophylaxes after procedure. All patients were followed for at least 12 months. Surgical site inflammation and infection were graded based on degree of inflammation, discharge, wound culture, and blood culture. Result Fifty‐eight patients developed surgical site inflammation and infection. Fourteen patients had culture‐positive wound infections. Among them, 13 patients had superficial wound infections with Staphylococcus species. Only one had pocket infection with Pseudomonas bacteremia . The surgical site infection rate was higher in those with longer procedural time, associated with 2.3 times more likelihood of infection (P = 0.01). Patients with an associated malignancy were associated with 3.6 times more likelihood of infection (P < 0.01). Conclusions Careful skin preparation prior to incision is important, whereas the use of topical antibiotics after closure has not shown significant benefit. Patients with malignancy and longer procedural times are more likely to develop infection. There is a trend for less infection with cephalic approach. Systemic antibiotics with staphylococcal coverage are needed as most of the wound culture positive infections are caused by Staphylococcus species.