Introduction and objectives: Current European and American guidelines recommend removing implantable cardiac electronic devices (ICED) in cases of systemic infection, while for infections localised to the device pocket, treatment decisions depend on the extent of involvement. This study aims to review our centre’s experience managing localised pocket infections conservatively with surgical cleaning (SC) without device removal, evaluating both safety and efficacy. Additionally, the study assesses the potential role of the antibiotic mesh Tyrx® (AM) as a secondary preventive measure, comparing outcomes of SC alone versus SC with AM to determine if both methods offer equivalent results.
Methods: We conducted a retrospective observational study including all patients who underwent SC for localised ICED pocket infections, all without systemic signs. Clinical data, device details, and prior interventions were recorded. Patients were followed through outpatient visits to monitor the necessity for device removal or further intervention. A multivariate analysis was performed to identify factors linked to failure of conservative management, while survival analysis was used to compare the effectiveness of SC alone versus SC plus AM.
Results: The study includes 253 patients treated with SC, 15 of whom also received AM. The median follow-up duration was 22.78 months. Patients had a mean age of 70 years, 84% were male, 54% had implantable cardioverter-defibrillators, and 23% had prior generator replacements. The average device age was 2.6 years. Baseline characteristics showed no significant differences between the two groups. Survival analysis demonstrated no statistically significant difference in outcomes between SC alone and SC combined with AM, indicating similar effectiveness.
Conclusion: This is the first report investigating the use of AM for secondary prevention in localised ICED infections. While AM may provide some benefit, no clear superiority over conservative antibiotic treatment alone was found in this patient cohort. Both approaches – medical antibiotic therapy alone and combined with antibiotic mesh – appear equally effective. Larger studies are necessary to clarify the definitive role of AM in this setting.