Device Infection Using Chlorhexidine Irrigation vs an Antibacterial Envelope: A Propensity Score-Matched Analysis.

BACKGROUND

Cardiac implantable electronic device (CIED) infection represents a significant cause of morbidity and increased health care costs in patients undergoing high-risk procedures.

OBJECTIVE

This study sought to describe the incidence of infection using two prevention strategies: chlorhexidine gluconate (CHG) pocket irrigation vs antibacterial envelope (ABE).

METHODS

In this retrospective observational study, patients undergoing high-risk CIED interventions (generator change, device upgrade, lead/pocket revision, cardiac resynchronization device implantation) between 2018 and 2024, in whom either CHG irrigation or ABE was used, were included. Propensity score matching using baseline and procedural characteristics (age, sex, previous infection, intervention within 60 days, type of device, type of intervention, PADIT [Prevention of Arrythmia Device Infection Trial] score, antibiotic used) was performed.

RESULTS

A total of 1,749 patients (median age 73 years [Q1-Q3: 63-81 years], female 42%; CHG: n = 1,118) were included. After a median follow-up of 459 days (Q1-Q3: 192-852 days), there were no statistically significant differences in the risk of CIED-related infection (0.8% vs 0.8%; HR: 0.89; 95% CI: 0.3-2.66; log-rank P = 0.83) between the CHG and ABE groups. After propensity score matching, a total of 714 patients, without statistically significant differences in baseline characteristics, were analyzed. There were no significant differences in the risk of CIED-related infection (1.1% vs 1.1%; HR: 0.97; 95% CI: 0.24-3.86, log-rank P = 0.96). No adverse events associated with CHG irrigation occurred.

CONCLUSIONS

In high-risk procedures, CHG irrigation resulted in a similar risk of CIED-related infection as treatment with an ABE, without any adverse events. The lower cost of CHG and widespread availability could result in more patients being treated, thus extending the benefits to patients with a lower risk of infection.