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Prevention of Device Infection: Procedural Aspects, Drugs, and Preventive Tools

  • Igor DiembergerEmail author
  • Giuseppe Boriani
  • Jean-Claude Deharo
Chapter
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Abstract

Although the recently reported results of the PADIT study [1] indisputably bring a positive message by showing that the infection rate within the first year after cardiac implantable electronic device (CIED) implantation in advanced care systems was “only” 1% in high-risk patients, infection associated with the use of CIED (CIEDI) remains a serious complication leading to significant morbidity and mortality. These infections can be the result of initial pocket infection, usually due to surgical site contamination (more frequently) or secondary to hematogenous seeding of the leads or pocket during an episode of bacteremia due to remote septic foci or associated with either intravascular catheters or invasive procedures. As previously discussed in Chaps.  3 and  4, the principal agents involved in the development of CIEDI are gram-positive Staphylococci, and the main factors promoting the infective process can be classified into (a) patient-related, (b) device-related, (c) procedure-related, and (d) related to operators’ experience. In this chapter, we will focus on the various aspects of periprocedural modifiable risk factors: anticoagulation, antisepsis, antibiotic prophylaxis, and wound care. We will discuss both available evidence supporting standard approaches and recently introduced devices to improve CIED procedures. On the contrary, prevention of CIEDI through adoption of new CIED technologies, patient-tailored choice of the device, implanting procedure, and long-term follow-up are discussed in Chaps.  10 and  12.

Keywords

CIED Infection Prevention Prophylaxis Pacemaker Defibrillator Surgical site infection Endocarditis Patient preparation 

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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Igor Diemberger
    • 1
    Email author
  • Giuseppe Boriani
    • 2
  • Jean-Claude Deharo
    • 3
    • 4
  1. 1.Department of Experimental, Diagnostic and Specialty Medicine, Institute of CardiologyUniversity of BolognaBolognaItaly
  2. 2.Cardiology Division, Department of Biomedical, Metabolic and Neural SciencesUniversity of Modena and Reggio Emilia, Policlinico di ModenaModenaItaly
  3. 3.Service de CardiologieCHU La TimoneMarseilleFrance
  4. 4.Faculté de Médecine NordAMU, UMR MD2MarseilleFrance

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