*2.7.1 General measures*

Any implant procedure must be performed following the usual aseptic surgical standards. Additionally, it is recommended to adhere to the following guidelines:


**131**

therapy.

*Endocarditis and Cardiac Device Infections DOI: http://dx.doi.org/10.5772/intechopen.96909*

patients [18, 26, 30].

*2.7.2 Antibiotic prophylaxis*

lones) [6, 18, 19, 26–30].

to both, assess linezolid/daptomycin.

intraprocedural antibiotic can be considered [12].

could be considered in high-risk patients [29, 30].

except in case of infected tissue manipulation [26].

**2.8 IE-CIED treatment**

*2.8.1 The removal of the device*

local antibiotic delivery is not recommended [6, 21, 30] as well.

• Consider the subpectoral implantation in malnourished or very thin

Antimicrobial prophylaxis should be administered on time to ensure, at the time of incision and throughout the procedure, that the tissue and plasma concentrations exceed the MIC for the microorganisms commonly associated with infection. This would normally be within 1 h for intravenous drugs given as a bolus or short infusion, but for some longer infusions that are given over 30 minutes or more, they may need to be started earlier to ensure that the infusion is completed at least 20 minutes before incision (e.g. vancomycin and fluoroquino-

Currently, the use of a dose of cefazolin (2 gr) or another first-generation cephalosporin or flucloxacillin (1–2 g) is recommended, one hour prior to the procedure. In patients allergic to Beta lactams or when the local incidence of MR Staphylococci is very high, vancomycin is recommended (vancomycin requires a mg/kg iv slower rate of infusion to prevent systemic vasodilatation and erythema within 2 hours before incision) or teicoplanin as an alternative regimen. If a glycopeptide is to be used, teicoplanin has some practical advantages over vancomycin in terms of administration as it can be given as a bolus (400 mg iv 5 minutes) rather than a long infusion. Teicoplanin resistance is more frequent than vancomycin resistance among Staphylococci (including CoNS), but both are uncommon. In case of allergy

In very prolonged procedures or in case of heavy bleeding, a second dose of

For elective procedures, *S. aureus* colonization can be detected by nasal swabs. Nasal treatment with mupirocin and chlorhexidine skin washing can reduce colonization and has been shown in some surgical studies to reduce the risk of infection, but there are no studies relating specifically to CIED interventions [6, 18, 30].

Antibiotic doses after wound closure are not recommended [6, 30]. The use of

Antimicrobial 'envelopes' have been developed to deliver antimicrobial agents locally into the generator pocket at the time of implantation or generator replacement. A product that delivers rifampicin and minocycline locally was tested in a randomized, controlled clinical trial WRAP-IT to assess its safety and efficacy in a population of patients who were at increased risk for CIED pocket infection. The envelope was significantly more effective at preventing infection than standard protocols. There is no formal recommendation for the use of these covers but it

Antimicrobial prophylaxis is not recommended for dental or other invasive procedures not directly related to device manipulation to prevent CIED infection,

Treatment is based on two pillars: the removal of the device and antimicrobial

Complete removal of the device, electrodes, or abandoned remains, is indicated in patients with any CIED infection, with the exception of superficial infections

**Figure 8.** *Pulmonary infectious involvement in IE-CIED. TC.*

• Consider the subpectoral implantation in malnourished or very thin patients [18, 26, 30].
