Microbial specturm and antibiotic sensitivity of pocket swabs in ICD patients undergoing device replacement or lead revision surgery- findings from a ICD registry observational study

Abstract Introduction Infection is a serious complication of implantable cardioverter defibrillator (ICD) therapy, necessitating effective preventive measures during implantation or revision surgery. The intraoperative use of antibacterial envelopes containing rifampicin and minocycline has shown promising results in reducing infection, yet, it is expensive and not cost-effective. Gentamicin sponges might be an alternative to the antibacterial envelope, however its efficacy on targeting the specific microbial spectrum found in device infection must be further investigated. Aim of the study was to identify the bacterial species obtained from pocket swabs of ICD patients undergoing revision surgery, and assess their sensitivity to gentamicin, rifampicin and minocycline. Methods A total of 459 intraoperative pocket swabs were collected from consecutive ICD patients who underwent elective device replacement, system upgrade or lead revision between 2017 and 6/2023. The baseline characteristics were similar in both groups (Table 1). Results Out of the 459 swabs analysed: 416 (90.6%) were negative for microbial growth. The remaining 43 swabs (9.4%) were tested positive for microbial growth (Table 2). Coagulase-negative- staphylococci (CoNS) were the most commonly isolated bacteria, accounting for 56% of cases. Bacteria with available antibiograms exhibited a sensitivity of 92% to gentamicin, 96% to rifampicin and 96% to Minocycline (Table 2). Conclusion The antibiotic sensitivity of the bacteria obtained from the pocket swabs to gentamycin, rifampicin and minocycline was similar. Thus, gentamicin sponges might be an alternative to the antibacterial envelope in patients with ICD undergoing generator replacement or revision surgery.