This document summarizes a clinical trial that compared additional antibiotic measures to a single preoperative dose of antibiotics in patients receiving cardiac implantable electronic devices. The trial involved over 19,000 patients randomized to either an incremental antibiotic strategy or conventional treatment. The results showed no significant differences in device infection rates, need for surgical intervention, or hospitalizations between the two groups. The study concluded that additional antibiotics were not superior to a single preoperative dose in reducing device infections, which remained low even in high-risk patients.

1. padit Trial
Prevention of Arrhythmia
Device Infection Trial
Cluster randomized crossover trial
Objective: To assess the efficacy of additional antibiotic
measures compared with a single dose of preoperative
antibiotics among patients undergoing implantation of a
cardiac implantable electronic device (CIED).
19,603
2018
Patients who required cardiac implantable
electronic device were randomized to:-
VS
primary outcome
secondary outcome
Hospitalization due to device
infection within 1 year %
Incremental
antibiotics
(n = 9,976)
Conventional
treatment
(n = 9,627)
OR: 0.77; 95% CI: 0.56 to 1.05; P=0.10
Need for
surgical intervention %
P=0.57
Hospitalizations in high
risk patients %
OR: 0.82; 95% CI: 0.59 to 1.15; P=0.26
0.8 1.0
1.0 1.1
1.0 1.2
Conclusion: The results of this trial indicate that a strategy of
additional antibiotics among patients undergoing CIED implanta-
tion is not superior a single dose of preoperative antibiotics in
reducing device infections. Overall infection rates were low, even
among patients deemed to be high-risk (~1%).
Krahn AD, et al. JACC. 2018 Dec 18;72(24):3098-3109.
Note: Incremental antibiotics treatment: pre-procedural cefazolin plus vancomycin,
intraprocedural bacitracin pocket wash, and 2-day post-procedural oral cephalexin.
Conventional treatment: pre-procedural cefazolin infusion