Plastic Surgery Research Council
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Presenter: Moris Topaz, MD, PhD, FRCSC
Co-Authors: Kazatsker M; Oron Y; Keren G; Silberman A; Carmel NN; Topaz G; Meisel SR; Frimerman A; Blondheim DS; Shotan A
Hillel Yaffe Medical Center

Background: The currently recommended treatment for infected cardiovascular implantable electronic device (CIED) is complete extraction and replacement. Our objective was to evaluate the safety and efficacy of an innovative therapy method of continuous in-situ-targeted, ultra-high dose antibiotics (CITA) under closed regulated negative pressure-assisted wound therapy (RNPT) system, for management of infection limited to their pockets and/or proximal leads, thereby reducing the need for extraction.

Methods: we designed a continuous, in-situ-targeted, ultra-high dose antibiotics (CITA) treatment under semi-closed, regulated, negative pressure-assisted wound therapy (RNPT) system (CITA-RNPT). We applied CITA-RNPT to consecutive patients diagnosed with: pocket and/or proximal lead infection, extruded CIEDs, or expanding hematoma.

Results: 31 patients, including 55% referrals from other centers, were treated by CITA-RNPT and, if indicated, by minor surgical procedures and were followed for 22.3 18.1 months (range 2-60). CITA-RNPT provided desired therapeutic antibiotics serum levels, whereas pocket concentrations obtained were 2-3 orders of magnitude higher, effectively eradicating the infection and salvaging 61% of CIEDs following a single course and 87% following additional courses of treatment. CITA-RNPT failed in only 4 patients (13%), whose device was subsequently extracted uneventfully. Treatment was associated with no major complications.

Conclusions: Our clinical and laboratory experience demonstrates that infection of CIED pocket and/or proximal subcutaneous portion of leads can be safely and effectively managed by CITA-RNPT, markedly diminishing the need for removal of the device. CITA-RNPT may be the first line therapy of infected implantable devices, managed by an experienced team only. Moreover, CITA also provides concurrent controlled systemic antibiotic administration therapy method, adjustable to the patient's requirements and constraints.

Key words: Implantable electronic devices device infection, antibiotic therapy.

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