• Yana Kakzanov, Yamama Alsana, Tal Brosh-Nissimov, Emanuel Harari, Michael Rahkovich, Yonatan Kogan, Emma Shvets, Gergana Marincheva, Lubov Vasilenko, and Avishag Laish-Farkash.
• Department of Cardiology, Samson Assuta Ashdod University Hospital, Ashdod, Israel, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
• Isr Med Assoc J. 2024 Nov 1; 26 (10): 636642636-642.

BackgroundCardiac implantable electronic devices (CIEDs) are associated with risks of device-related infections (DRI) impacting major adverse outcomes. Staphylococcus aureus (SA) is a leading cause of early pocket infection and bacteremia. While studies in other surgical contexts have suggested that nasal mupirocin treatment and chlorhexidine skin washing may reduce colonization and infection risk, limited data exist for CIED interventions.ObjectivesTo assess the impact of SA decolonization on DRI rates.MethodsWe conducted a retrospective, single-center observational study on consecutive patients undergoing CIED interventions (March 2020-March 2022). All patients received pre-procedure antibiotics and chlorhexidine skin washing. Starting in March 2021, additional pre-treatment with mupirocin for SA decolonization was administered. DRI rates within 6 months post-implantation were compared between patients treated according to guidelines (Group 1) and those receiving mupirocin in addition to the recommended guidelines (Group 2).ResultsThe study comprised 276 patients (age 77 ± 10 years; 60% male). DRI occurred in five patients (1.8%);80% underwent cardiac resynchronization therapy procedures. In Group 1 (n=177), four patients (2.2%) experienced DRI 11-48 days post-procedure; three with pocket infection (two with negative cultures and one with local Pseudomonas) and one with methicillin-sensitive SA endocarditis necessitating device extraction. In Group 2 (n=99), only one patient (1%) had DRI (Strep. dysgalactiae endocarditis) 135 days post-procedure (P = NS).ConclusionsThe routine decolonization of SA with mupirocin, in addition to guideline-directed protocols, did not significantly affect DRI rates. Larger prospective studies are needed to evaluate the preventive role of routine SA decolonization in CIED procedures.

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