Background: Implantable cardiac device infection is a well-recognized complication. No prior efforts were made to systematically evaluate this problem in Latin American Centers. The aim of this study was to determine the prevalence of implantable cardiac device infection and its management in Latin American centers.
Methods: All implantable cardiac device procedures performed between April 1st2013 and March 31st 2014 were retrospectively analyzed. Data were obtained on the characteristics and resources of participating centers (public or private institution, number of beds, number of procedures,infection rate, infection management, type of antibiotics used and, type of leads and devices) through an online survey.
Results: Data of procedures were received from 50 centers in 32 participating cities from 10 countries (Argentina, Brazil, Chile, Colombia, Cuba, Ecuador, Mexico, Peru, Uruguay, and Venezuela). Six (12.4%) centers implanted less than 50 devices per year; 14 (28.6%) between 50 and 100; 20 (40.8%) between 100 and 200 and 9 (18.4%) more than 200 and 1 didn’t complete this data. Most of them (89.8%) used active atrial lead and 8.2% passive fixation, data was not available in the other 2%. Infection rate was reported by 35 centers (66%). Among them, 25 (71%) centers presented less than 3 cases, between 3 and 5 cases 5 (14.5%) and more than five, 5 (14.5%). All of them (50) performed systemic antibioticprophylaxiswith first or second generation cephalosporin and 24% performed local prophylaxis on the pocket with gentamicine, amika or vancomicine. Due to pocket infection without systemic infection, 35 (70%) of the centers remove the whole system and performed contralateral implantation on a second time. Seven (14%) centers perform pocket surgery revision and antibiotics, and 8 (16%) centers only antibiotics. In the case of device exteriorization without systemic infection, 41 (82%) remove generator and leads, perform antibiotics treatment and reimplantin the contralateral side; 9 (18%) perform pocket revision with extraction and disinfection of the device without changing leads. Waiting time for a re-implant after an infection was ? 7 days (43 centers, 86%) and ? 7 days in 7 (14%). Transesophageal echocardiogram was performed in the 74% of the centers to confirm the diagnosis. About 50% of the centers used percutaneous steels for removing the leads. The centers with lower number of implants (? than 50 per year) presented the largest infection rate as well as those that use passive atrial fixation
Conclusions: Infection rates in Latin America remains a challenge in Latin American centers. Antibiotic prophylaxis is standard and management varies with the centers. Centers with lower volumes and/or using passive atrial fixationseemed to be exposed to a higher complication rate.