Use of taurolidine vs conventional profilaxis to reduce cardiac implantable electronic device infection in a prospective observational one-center study

Introduction

Taurolidine is an antimicrobial solution designed to prevent infections from cardiac implantable electronic devices (CIED). Taurolidine has a broad antimicrobial activity against all relevant pathogens, including (but not limited to) multi-resistant (e.g. MRSA, MRSE, Klebsiella, Candida sp.). Polyvinylpyrrolidone (PVP) alters the kinetics of action by prolonging the efficacy, depending on the prevailing pH and the area to be treated.

Material and Methods

We design a prospective observational one-center study from November 10th, 2023 to November 10th, 2025 in which we included all patients who underwent a procedure including a pacemaker, an ICD, CRT or LBBB pacemaker implant or replacement. All patients had previous IV antibiotic profilaxis (cefazolin or vancomycin) and were classified in 2 groups depending of additional use of local taurolidine or not. All patients were routinely reviewed at 1 and 12 months post-procedure follow-up visit, unless the procedure had a complication which was described.

End point: The primary endpoint was ‘major’ CIED infection. The secondary endpoints were death from any cause and adverse events.

Results

We include a total of 210 patients: 130 patients received conventional prophylaxis (gentacoll or none) and 80 were performed with taurolidine. Four patients had an infection related complication in the conventional group, one developed infective endocarditis, 2 had pocket related infection. (1 Pseudomona sp, 1 Staphylococcus capitis). There were no infection complications in the taurolidine group.

Conclusions

In our experience intraoperative taurolidine is effective in reducing acute CIED infection. More studies should be made with a wider population to confirm this results.