Antibiotic prophylaxis based on individual infective risk stratification in cardiac implantable electronic device: the PRACTICE study.

5 The Shariff score was tested in a retrospective large cohort of patients with a median follow-up of 48 months: a score >3 at first implantation was an independent predictor of CIED infection while a score = 3 reached borderline significance. 6 Systemic antibiotic prophylaxis is recommended by international consensus and represents the standard of care. 7 The recommendations from the major heart rhythm societies clearly indicate to administer antibiotics 1 h prior to skin incision and suggest to prefer drugs that coverage Staphylococcus aureus species such as beta-lactams and glycopeptides. 7 Post-operative antibiotics administration has weak evidence, and its administration varies according to centre and operator practice.

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In the large, randomized, PADIT Trial, an incremental antibiotic prophylaxis covering the perioperative period and the subsequent 2 days, compared with conventional preprocedural prophylaxis alone, resulted in a modest reduction in CIED-related infection that did not reach statistical significance, probably due to low rates of events. 14 However, the antibiotic protocol was not tailored based on individual infective risk and the prolonged protocol was for only 2 days.

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