Perspective:

Pocket infections account for about 30-60% of cardiac implantable electronic device infections. The standard of care of pocket infections requires a complete removal of those devices along with extraction of all intracardiac electrodes. In this avant-garde and provocative study, the authors undertook opening the pocket, debridement, pocket cleansing with 1.5% hydrogen peroxide and 5% povidone-iodine, percutaneous insertion of a 6 French catheter, and administration of antibiotics directly into the pocket continuously for 10-14 days. The authors report relatively high rates of long-term clearing of infections without removal of the hardware. It is imperative to note that patients with signs of systemic infection, fever, positive blood cultures, or lead vegetations were excluded from this approach, as were patients with Staphylococcus aureus. This study presents a possible option for high-risk extraction patients, which may be associated with more favorable outcomes than chronic suppressive antibiotic therapy. A lot of further research will have to be done before this can be more broadly accepted.