Surgical prophylaxis for implantable cardiac device insertion
Consider the principles for appropriate prescribing of surgical antibiotic prophylaxis (see Principles for appropriate prescribing of surgical antibiotic prophylaxis). See Implantable cardiac device insertion procedures and their requirement for surgical antibiotic prophylaxis for the recommendations for surgical prophylaxis for implantable cardiac device insertion.
For a printable summary table of the indications and regimens for surgical antibiotic prophylaxis, see here.
|
Procedures |
Is surgical antibiotic prophylaxis indicated? |
|---|---|
|
insertion of an implantable cardiac device (eg permanent pacemaker device, cardioverter defibrillator, cardiac resynchronisation device, ventricular assist device) |
YES |
The choice of prophylaxis for ventricular assist device insertion should be guided by local microbiology and the optimal duration of prophylaxis is unclear—refer to local protocols or seek expert advice.
For prophylaxis for insertion of other implantable cardiac devices, use:
cefazolin 2 g (child: 30 mg/kg up to 2 g) intravenously, within the 60 minutes before surgical incision; intraoperative redosing may be required (see here ). Do not give additional doses once the procedure is completed. surgical prophylaxis, cardiac (implantable device insertion) cefazolin
For patients colonised or infected with methicillin-resistant Staphylococcus aureus (MRSA), or at increased risk of being colonised or infected with MRSA (see Risk factors for infection with methicillin-resistant Staphylococcus aureus), add vancomycin to cefazolin:
vancomycin (adult and child) 15 mg/kg up to 2 g intravenously, started within the 120 minutes before surgical incision (recommended rate 10 mg/minute)1; intraoperative redosing may be required (see here ). Do not give additional doses once the procedure is completed. surgical prophylaxis, cardiac (implantable device insertion) vancomycin
For patients with immediate nonsevere or delayed nonsevere hypersensitivity to penicillins, use cefazolin, with or without vancomycin, as above. See also Surgical antibiotic prophylaxis for patients with a penicillin or cephalosporin allergy.
For patients with immediate severe or delayed severe hypersensitivity to penicillins, use:
vancomycin (adult and child) 15 mg/kg up to 2 g intravenously, started within the 120 minutes before surgical incision (recommended rate 10 mg/minute)2; intraoperative redosing may be required (see here ). Do not give additional doses once the procedure is completed vancomycin
PLUS
gentamicin (adult and child) 2 mg/kg up to 180 mg intravenously over 3 to 5 minutes, within the 120 minutes before surgical incision34; intraoperative redosing is unlikely to be required (see here ). Do not give additional doses once the procedure is completed. surgical prophylaxis, cardiac (implantable device insertion) gentamicin
A single preoperative dose of surgical antibiotic prophylaxis is sufficient to prevent postoperative infection. Postoperative (intravenous or oral) antibiotics do not provide benefit and increase the risk of subsequent infections with resistant pathogens and Clostridioides difficile.
Applying antimicrobials (eg ointments, solutions, powders) to the surgical incision to prevent surgical site infection is not recommended because there is potential for harm (eg hypersensitivity reactions, bacterial resistance) and inadequate evidence to support a benefit.