Device-related infection in a large tertiary center-Benefit of the antibacterial envelope

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. BACKGROUND: Cardiac implantable electronic device (CIED) infection carry a high morbidity and mortality. According to current data, the risk for a device-related infection is in a range of 0.6-3.4 % due to the latest EHRA consensus practical guide (reference 1). The use of an antibacterial envelope was associated with a reduced risk for infection in a large randomized trial (reference 2). METHODS: Retrospective analysis of the one-year risk of device-related infections in a large tertiary center in Switzerland during the time period of 2014-2019 (period A where the antibacterial envelope used only occasionally) in comparison to the risk of infection during the year 2020 (Period B, one year where in all device-interventions an antibacterial envelope was used). The presence of a local or systemic, device-related infection was counted as an infection event. RESULTS: In this retrospective analysis from two large Swiss implantation centres, a total of 1776 patients were included from the time period 2014-2020. 1’457 derived from period A (2014-2019) where the antibacterial envelope was only used in 2.6 % of the interventions compared to period B with 319 patients where in all interventions the envelope was present. There were no demographic or baseline characteristic differences between the two groups (table 1) except for the presence of a larger population of patients suffering from valvular heart disease (30.3 % during period A versus 10.8 % during period B) but without an relevant difference in the use of anticoagulation. The risk for device-related infection during period A was 0.96 % (N=14) versus only 0.63 % (N=2) during time period B which equals a relative risk reduction of 34.8 %. CONCLUSIONS: The use of the antibacterial envelope during device-interventions was associated with a 34.5% relative risk reduction in a large tertiary Swiss center. Keeping in mind the potential additional burden of device-infection related treatment, it is of paramount importance to reduce the risk for device-associated infections. [Figure: see text]