The safety, efficacy and cost-effectiveness of gentamycin-collagen sponge in multi-component prevention strategy of cardiac implantable electronic device infections - the single-center experience.

BACKGROUND Cardiac implantable electronic device (CIED) infections are associated with significant morbidity, mortality and increased health care expenses. Apart from standard systemic antibiotic therapy locally acting agents are under investigation as potential approach for prevention of this complication. AIMS The aim of our study was to summarize our experience with gentamycin-collagen sponge (GCS) in multi-component prevention strategy of cardiac implantable electronic device infection. METHODS We retrospectively analyzed medical records of 312 consecutive patients who underwent CIED-related surgery and had at least 6 months follow-up. All the individuals had GCS applied during surgery. An incidence of CIEDs-related infection in our group was compared to risk level calculated according to commonly used scores. An analysis of cost-effectiveness was also performed. RESULTS Incidence of CIED-related infection, defined as primary endpoint, occurred relatively rarely (0.33%) as compared to the infection risk calculated according to commonly used scores (PADIT - 0.83%; CIED-AI - 0.90% or Mittal score - 1.00%; P <0.001 - for all). We did not record any complication related to GCS. We analyzed cost-effectiveness of our GCS-based approach, which appeared to be financially beneficial (number needed to treat 149-200; difference of CIED infection treatment cost and GCSs price was 5093-26525 $). CONCLUSIONS We conclude that: 1) use of GCS to reduce CIEDs infections is feasible and safe; 2) our multi-component prevention strategy involving the GCS application seems to significantly reduce rate of CIED infection and it is cost-effective.