Abstract Background Cardiovascular implantable electronic devices (CIEDs) improve survival in patients with cardiac rhythm disorders but carry risks of complications, most notably major infections. Reported infection rates vary internationally, and contemporary large-scale data from Germany are scarce. We aimed to determine nationwide rates of CIED infection-related hospitalizations and associated mortality over a five-year period. Methods We analyzed administrative claims from Germany’s largest statutory health insurer covering more than 27 million beneficiaries. All CIED procedures performed between January 2015 and December 2019 were identified, including initial implantations, upgrades or downgrades, generator replacements, early revisions, and device extractions. Major infections were detected using International Classification of Diseases (ICD-10-GM) and procedural codes, and stratified as generator pocket infections or lead-associated endocarditis. In-hospital mortality was determined from discharge records. Results Among 282,205 patients (57.7% male) undergoing CIED procedures, 6,577 individuals (2.33%) experienced 7,704 major infections within three months. Generator pocket infections occurred in 5,396 cases (1.91%), lead-associated endocarditis in 2,308 (0.82%), and combined infections in 1,127 patients (0.39%) within the acute 90-day observation period. CIED infections substantially increased healthcare utilization: Infected patients required substantially more procedures than non-infected patients, despite correct treatment. In-hospital mortality reached 8.36% for pocket infections and 15.0% for endocarditis. Extended follow-up in the 2015 cohort revealed a 4.33% infection-related procedure rate over five years. Conclusions Nationwide German data reveal higher acute CIED infection rates than previously reported, with considerable mortality and procedural burden. These findings highlight an urgent need for improved prevention and management strategies.

Abstract Infections associated with cardiac implantable electronic devices (CIEDs) pose significant clinical challenges due to their life-threatening nature and complex management. Recent advancements in prevention, diagnosis, and treatment have been driven by landmark trials such as PADIT and WRAP-IT, alongside evolving diagnostic tools like [18 F]FDG PET/CT and updated diagnostic criteria (e.g., 2023 Duke-ISCVID). A combination of well-established approaches—such as leadless pacemakers, subcutaneous ICDs, and an antibiotic-eluting envelope—and evolving adjunctive strategies, including a taurolidine-containing antimicrobial agent, incision drapes, fascial plane blocks or double gloving, have broadened the spectrum of options to reduce and potentially mitigate the risk of CIED infection. While devices like leadless pacemakers, subcutaneous ICDs, and antibiotic envelopes are supported by randomized controlled trials, adjunctive measures such as taurolidine rely predominantly on observational data. To address this variation in the strength of available evidence, a modified Delphi consensus process was conducted, bringing together cardiologists and infectious disease experts to define experience-based best practices in areas where current guidelines offer limited or no specific recommendations. The consensus achieved strong agreement (≥ 80%) on key strategies, including mandatory double-gloving to reduce contamination, the use of validated risk models (e.g., PADIT, BLISTER) for tailored infection prevention employing an antibiotic eluting envelope, multidisciplinary decision-making for non-extractable infections and the use of taurolidine solutions as adjuncts to prevent CIED infection. Moderate consensus (60–79%) supported non-delayed reimplantation after lead-related endocarditis and single-session reimplantation in pacing-dependent patients under specific circumstances. However, no consensus was reached on mandating a minimum annual procedural volume (≥ 500 cases) for CIED centers, reflecting concerns about access and operator expertise. The findings emphasize the importance of personalized risk stratification, procedural innovations, and multidisciplinary collaboration in optimizing CIED infection outcomes. Areas requiring further research include the efficacy of iodophor-impregnated drapes, fascial plane blocks, and taurolidine solutions. This consensus provides a pragmatic framework for clinicians, highlighting evidence-informed strategies to mitigate infection risks and improve care for patients undergoing CIED procedures.

Implantable medical devices, including cardiac electronic implants, joint prostheses, and breast implants, are essential to modern healthcare but remain susceptible to infection from microbial contamination during placement. Staphylococcus spp. and Candida albicans are the predominant pathogens, often causing severe complications, increased mortality, and substantial healthcare costs. With antibiotic resistance on the rise, intraoperative surface disinfection has emerged as a critical yet underutilized preventive strategy. Taurolidine, a broad-spectrum antimicrobial with a strong safety profile and no known resistance, can be applied directly to both tissues and device surfaces. To replicate intraoperative decontamination, taurolidine-saturated swabs are tested under standardized mechanical wiping using the European Norm EN 16615 "4-field test." The model reproduced short contact times and organic load conditions reflective of clinical practice, enabling assessment of both chemical and mechanical antimicrobial effects. Taurolidine achieved >5 log10 reductions in Staphylococcus aureus, Pseudomonas aeruginosa, and Candida albicans, and >4 log10 for Enterococcus hirae. The observed activity demonstrated a surface-driven, enzyme-independent mechanism involving spontaneous release of reactive N-methylol functional groups that disrupt microbial membranes. Taurolidine's enzyme-independent antimicrobial mechanism distinguishes it from solvent- or oxidant-based disinfectants. These results support taurolidine as a potential adjunctive prophylactic agent to reduce device-related infections during implantation procedures.

In this study, we present a novel face mask engineered for the collection of exhaled breath condensate (EBC) and its application and performance in a clinical study of COVID-19 infection status assessment versus the gold standard polymerase chain reaction (PCR) nasopharyngeal swab testing. EBC was collected within a clinical trial of COVID-19-infected and non-infected patients and analyzed by reverse transcription quantitative (RT-q) PCR, with the results being compared with nasopharyngeal sampling of the same patient. The cycle threshold (Ct) values of the nasopharyngeal samples were generally lower than those of EBC, with viral loads in EBC ranging from 1.2 × 104 to 5 × 108 viral particles mL−1 with 5 min of breathing. From the 60 clinical patients’ samples collected, 30 showed a confirmed SARS-CoV-2 infection. Of these 30 individuals, 22 (73%) had Ct values < 40 (representing the threshold for SARS-CoV-2 infectivity) using both amplification of ORF1a/b and the E-gene. The 30 EBC samples from non-infected participants were all identified as negative, indicating a 100% specificity. These first results encourage the use of the face mask as a noninvasive sampling method for patients with lung-related diseases, especially with a view to equipping the face mask with miniaturized sensing devices, representing a true point-of-care solution in the future.

Background: Cardiac implantable electronic devices (CIEDs) are vital for managing arrhythmias but carry a notable risk of infection, which increases patient morbidity, mortality, and healthcare burden. This review examines current evidence on risk factors and preventive strategies for CIEDI. Methods: A structured search was performed in PubMed, Embase, and the Cochrane Library using terms such as “CIED,” “infection,” “pacemaker,” “ICD,” “infection prevention,” “biofilm,” “antibiotic prophylaxis,” and “antibiotic-eluting envelope.” Study selection followed PRISMA guidelines. Results: For well-established topics, recommendations are based on high-quality evidence from the literature. In areas with limited CIED-specific data, evidence from related surgical fields was considered, and expert consensus was used to guide recommendations. Conclusions: This review offers practical guidance for clinicians on CIED infection prevention, addressing gaps not previously covered in existing guidelines.

Background: Central venous access devices (CVADs) are crucial for various medical conditions, but pose risks, including catheter-related bloodstream infections (CRBSI). CRBSI increases comorbidity, mortality, and healthcare costs. Surveillance and evidence-based guidelines have successfully reduced CRBSI rates, although the COVID-19 pandemic has led to increased infection rates. Main body: This review explores strategies for reducing the incidence of CRBSI and examines factors contributing to variations in reported rates across developed countries. Highlighting the significant morbidity, mortality, and healthcare resource burden associated with CRBSI, the analysis delves into evidence-backed preventive measures. It discusses the impact of the COVID-19 pandemic on infection rates and proposes resilient strategies in response to these challenges. The review emphasises the importance of understanding CRBSI pathogenesis, patient, procedure, and device-related risk factors, and the implementation of evidence-guided algorithms and surveillance measures. Recommendations include the use of all-inclusive procedure packs, ultrasound-guided placement, daily dressing changes with antimicrobial treatment, and the use of antimicrobial locks. Conclusions: The review underscores the need for clear, concise algorithms adaptable to various healthcare settings and the scalability of infection prevention systems to ensure resilience.

Introduction: Cleaning and reduction of microbial load on the skin is necessary before injections because of the colonization of the skin with resident flora and the presence of transient flora. Even after optimal skin antisepsis, there is a risk of infection, albeit a very low one. The World Health Organisation (WHO) based on a systematic review on the infection risk after injections and skin antisepsis, does not recommend, alcohol-based skin antisepsis as being necessary before intradermal, subcutaneous and intramuscular injections and that washing the skin with soap and water alone is sufficient. As there is no clear evidence for the benefit of using alcohol over soap washing prior to injection, this study compared the efficacy of alcohol and soap on volunteers. Method: Liquid washing emulsion or potash soap (Sapo Kalinus, German Pharmacopoeia) or propan-2-ol 70%v/v, was applied to test areas on the upper arms of 23 volunteers. To test the soap, in trial 1 after 15-second swabbing, and a further 15 seconds of air-drying, the swabbed areas were rinsed, dabbed dry, and microbiological samples taken with sterile swabs. In trial 2, after 15 seconds of swabbing, samples were taken in the same manner. The comparator alcohol was rubbed in for 15 seconds in trial 1 and for 30 seconds in trial 2 without rinsing. Swabs were transferred into tryptic soy broth and suspensions plated onto agar. Results: The reduction of bacteria was around 1x lg and did not differ significantly between the soaps and propan-2-ol. There was also no difference when comparing the two trials. Discussion: One reason for the equivalent efficacy of both methods is probably the low colonization density of the skin of the arms. Conclusion: Both methods are acceptable for legal reasons. However, if no live vaccines are applied, alcohol-based antiseptics are preferable because they are more user-friendly.

The global rise in infections associated with cardiovascular implantable electronic devices (CIEDs) is a matter of increasing concern. However, comprehensive and detailed data on the incidence and consequences of these infections within the German-speaking population remain limited. This study aims to provide an extensive analysis of the incidence of acute CIED-related procedures, hospital admissions due to CIED infections, and the associated mortality rates in Germany. For this investigation, we analysed the billing data from Germany’s largest health insurance provider, AOK, focusing on the number of CIED-related procedures and associated infections in 2019. To identify cases of CIED infections, we utilised specific procedural codes (OPS) and the International Classification of Diseases, 10th Revision, German Modification (ICD-10-GM). In a second step, infections were categorised as either local CIED pocket infections or CIED-related endocarditis. The patients’ discharge status was also documented. In 2019, among the 27 million AOK members, a total of 51,992 patients (of whom 58.0% were male) underwent one or more CIED-related procedures. Of these, 1,051 patients (2.02%) required hospitalisation due to localised CIED infections or the development of such infections within three months post-procedure. The occurrence of these infections was associated with an increased mortality rate of 8.7%. Additionally, 508 patients (0.97%) were hospitalised due to CIED-associated endocarditis, resulting in an elevated mortality rate of 14.0%. Patients with CIED pocket infections and CIED-related endocarditis were, on average, younger (median age 70.2 and 66.8 years, respectively, compared to 74.0 years in patients without infections) and more frequently male (69.5% and 71.3%, respectively, compared to 58.0%). On average, patients with CIED infections required 2.74 additional procedures, whereas patients with endocarditis required an average of 2.37 additional procedures. This study indicates an elevated prevalence of acute CIED infections compared to previous reports. The requirement for multiple additional interventions may suggest insufficient adherence to treatment guidelines for CIED infections, potentially impacting patient outcomes negatively. These findings underscore the importance of improved compliance with infection prevention protocols to mitigate the burden of such infections.Flow Chart

The placement of cardiovascular implantable electronic devices (CIED) comes with a risk of adverse events (AE). AE comprise complications associated with the procedure and the device. CIED infection is a severe AE. Reported CIED infection rates are regionally differing and publications of contemporary large cohort data regarding CIED infections for Germany are lacking. This investigation provides rates of CIED infection related hospital admission and CIED infection related mortality in Germany. Data from Germany's largest healthcare insurance fund was screened for CIED procedures during the period: January to December 2015. These data included placement, revision with aim to up- or downgrade, generator substitution, early revision and partial or complete extraction using specific procedure codes for reimbursement. Among the total population of beneficiaries undergoing CIED procedures, International Classification of Diseases codes (ICD 10 GM), operational and procedural codes for partial or complete hardware removal were used to identify CIED infections and lead related endocarditis. To report the corresponding mortality rates, the hospital discharge status was documented. In 2015, from a population of more than 27 million beneficiaries, we identified the cohort of 60,296 patients (57.3% male) who underwent any invasive CIED procedure. Within three months from the index procedure, 1,595 patients developed a major CIED infection. 1,129 (1.87%) were related to the generator pocket and 466 (0.8%) were related to the transvenous proportions of the leads, mortality after those infections was 8.4% and 15.24%, respectively. In summary, our data reveals a higher prevalence of acute CIED infection than previously noted. The elevated number of additional procedures in cases of CIED infection implies a deficiency in infection awareness.

Currently, povidone-iodine (PVP-I) and hydrogen peroxide (H2O2) are frequently used antiseptics in joint infections, but the cytotoxic effects of these solutions are already reported. N-chlorotaurine (NCT) shows a broad-spectrum bactericidal activity and is well tolerated in various tissues, but its effect on human chondrocytes is unknown. The purpose of this study was to assess the cytotoxic effect of NCT, PVP-I, and H2O2 on human chondrocytes compared to a control group in an in vitro setting to get first indications if NCT might be a promising antiseptic in the treatment of septic joint infections for the future. Chondrocytes extracted from human cartilage were incubated with various concentrations of NCT, PVP-I, and H2O2 for 5 and 30 min respectively. EZ4U cell viability kit was used according to the manufacturer’s recommendations determining cell viability. To assess cell viability based on their nuclear morphology, cells were stained with acridine-orange and identified under the fluorescence microscope. EZ4U kit showed after 5 and 30 min of incubation a significant decrease in cell viability at NCT 1

Abstract Introduction Infection is a significant complication of cardiac implantable electronic device (CIED) therapy. The European TauroPace™ Registry investigates the safety and efficacy of TauroPace™ (TP), an antimicrobial solution containing taurolidine, designed to prevent CIED infections. Methods This multicenter study included patients undergoing CIED procedures at participating centers where TP was used as a disinfectant for external hardware surfaces and an antiseptic for irrigating surgical sites. All patients eligible for CIED placement with adjunctive TP as the standard of care were included. Other aspects of CIED procedures adhered to current guidelines. Data on CIED-related infective endocarditis, CIED pocket infection, device and procedure-related complications, adverse events, and all-cause mortality were prospectively collected for 12 months. In cases of revision, the previous procedure was censored, and a new procedure was created. Binomial and Kaplan–Meier statistics were employed to analyze event rates. Results From January 2020 to November 2022, TP was used in 822 out of 1170 CIED procedures. Among patients who completed the 3-month follow-up, no CIED pocket infections were observed, and one case of CIED-related infective endocarditis was reported. In the 12-month follow-up cohort, two additional local pocket CIED infections were observed, resulting in a total of three major CIED infections within 1 year after the CIED placement procedure. The 3-month and 12-month major CIED infection rates were 0.125% and 0.51%, respectively. During the observation a complication rate of 4.4% was reported. No adverse events related to TP were observed. Conclusions TP appears to be effective and safe in preventing CIED infections. ClinicalTrials.gov Identifier: NCT04735666.

BackgroundThe study aimed to evaluate the prevalence and pattern of long COVID-19 (LC) symptoms among individuals who had contracted COVID-19, to calculate the incidence of LC, and to provide insights into risk factors associated with developing LC in this population.MethodsThis population-based cross-sectional survey was conducted in Fars province in 2023. Adult participants with a history of COVID-19 were recruited using a cluster random sampling method, alongside a control group with similar characteristics through the same methodology. Data were collected through in-person interviews using two researcher-developed data collection forms focused on demographic and clinical information.ResultsA total of 2010 participants, comprising 1561 (77.7%) and 449 (22.3%) individuals with and without a previous history of COVID-19 were included. Among those with COVID-19 history, the prevalence of experiencing any symptoms was 93.7% (95% CI of 92.3%-94.8%) during the disease acute phase and 36.4% (95% CI of 34.0%-38.8%) after recovery. The incidence of symptoms specifically related to COVID-19, calculated by comparing the symptom rates between participants with and without a history of COVID-19, was found to be 13%. Factors such as older age, previous hospitalization for COVID-19, presence of cardiovascular disease, and use of steroids/chemotherapy were associated with LC symptoms.ConclusionsOur investigation sheds light on long-term aspects of COVID-19, demonstrating a significant prevalence of LC with diverse manifestations. It also underscores the importance of establishing standardized criteria and control groups in research on LC to address challenges related to heterogeneity and potential overestimation of symptoms.

ZusammenfassungDie Komplikationen nach Schrittmacherimplantation sind vielfältig. Neben Dislokation der Elektroden, Twiddler-Syndrom, Fehlfunktion und Hämatombildung kann es zu Schrittmacherinfektionen kommen. Diese können in akute, subakute und späte Infektionen unterteilt werden. Sowohl der Zeitpunkt des Auftretens als auch der Infektionsweg spielen eine entscheidende Rolle. Die Folgen einer Schrittmacherinfektion sind verheerend. Zur leitliniengerechten Behandlung gehört die Entfernung aller implantierten Anteile des Schrittmachers (transvenöse und subkutane Anteile). Wird keine vollständige Entfernung vorgenommen, kommt es häufig erneut zur Infektion. Die offene Thoraxchirurgie zur Entfernung infizierter Schrittmacherkomponenten ist mittlerweile durch perkutane Extraktionsverfahren ersetzt worden. Die Sondenextraktion erfordert spezielles Gerät und Expertise, welche nicht immer vorhanden sind. Zudem ist sie nicht bei jedem Patienten durchführbar. Jedes Extraktionsverfahren ist mit einem geringen Risiko potenziell tödlich verlaufender Komplikationen verbunden (z. B. Einriss kardialer oder vaskulärer Strukturen, Hämatothorax oder Herztamponade). Aus genannten Gründen sollte die Durchführung solcher Verfahren spezialisierten Zentren mit entsprechender Ausrüstung und Erfahrung vorbehalten sein. In diesem Fallbericht werden die Schritte zur erfolgreichen Revision eines Herzschrittmachers bei einem fragilen Patienten ohne Möglichkeit der Extraktion erläutert, welcher sich mehr als 5 Jahre nach Generatorwechsel mit einer Fistel im Bereich der Generatortasche in unserer Ambulanz vorstellte.

Journal of Wound CareVol. 32, No. 1 EditorialWhen is antibiotic therapy necessary for patients with infections in hard-to-heal wounds?Ojan Assadian, Karen J Ousey, Leigh Fleming, Rakesh Mishra, Joanna Blackburn, Fabiola SigmundOjan AssadianMedical Director, Regional Hospital Neustadt, Vienna, Austria; Institute of Skin Integrity and Infection Prevention, University of Huddersfield, UKSearch for more papers by this author, Karen J OuseyProfessor and Director for the Institute of Skin Integrity and Infection Prevention, University of Huddersfield, UKSearch for more papers by this author, Leigh FlemingReader, Director of Home Recruitment, School of Computing and Engineering, Institute of Skin Integrity and Infection Prevention, University of Huddersfield, UKSearch for more papers by this author, Rakesh MishraProfessor and Co-director for the Centre for Thermofluids, Energy Systems and High Performance Computing, School of Computing and Engineering, Institute of Skin Integrity and Infection Prevention, University of Huddersfield, UKSearch for more papers by this author, Joanna BlackburnResearch Fellow, Institute of Skin Integrity and Infection Prevention, University of Huddersfield, UKSearch for more papers by this author, Fabiola SigmundClinical Research Coordinator, Regional Hospital Wiener Neustadt, AustriaSearch for more papers by this authorOjan Assadian; Karen J Ousey; Leigh Fleming; Rakesh Mishra; Joanna Blackburn; Fabiola SigmundPublished Online:11 Jan 2023https://doi.org/10.12968/jowc.2023.32.1.3AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References 1 International Wound Infection Institute (IWII) Wound infection in clinical practice. Wounds International. 2022. https://woundinfection-institute.com/resources/ (accessed 7 December 2022) Google Scholar2 Kramer A, Dissemond J, Kim S et al.. Consensus on wound antisepsis: update 2018. Skin Pharmacol Physiol 2018; 31(1):28–58. https://doi.org/10.1159/000481545 Crossref, Medline, Google Scholar3 Müller G, Kramer A. Biocompatibility index of antiseptic agents by parallel assessment of antimicrobial activity and cellular cytotoxicity. J Antimicrob Chemother 2008; 61(6):1281–1287. https://doi.org/10.1093/jac/dkn125 Crossref, Medline, Google Scholar4 Roberts CD, Leaper DJ, Assadian O. The role of topical antiseptic agents within antimicrobial stewardship strategies for prevention and treatment of surgical site and chronic open wound infection. Adv Wound Care (New Rochelle) 2017; 6(2):63–71. https://doi.org/10.1089/wound.2016.0701 Crossref, Medline, Google Scholar5 Dissemond J, Assadian O, Gerber V et al.. Classification of wounds at risk and their antimicrobial treatment with polihexanide: a practice-oriented expert recommendation. Skin Pharmacol Physiol 2011; 24(5):245–255 Crossref, Medline, Google Scholar6 World Union of Wound Healing Societies (WUWHS). Principles of best practice: wound infection in clinical practice. An international consensus. Int Wound J 2008; 5(suppl 3):iii–11. https://doi.org/10.1111/j.1742-481x.2008.00488.x Crossref, Google Scholar7 Kingston D, Seal DV. Current hypotheses on synergistic microbial gangrene. Br J Surg 1990; 77(3):260–264. https://doi.org/10.1002/bjs.1800770309 Crossref, Medline, Google Scholar8 Itani KMF, Shorr AF. FDA Guidance for ABSSSI trials: implications for conducting and interpreting clinical trials. Clin Infect Dis 2014; 58(Suppl 10):S4–S9. https://doi.org/10.1093/cid/cit612 Crossref, Medline, Google Scholar9 Bodmann KF, Grabein B, Kresken M. S2k guideline ‘Calculated parenteral initial treatment of bacterial infections in adults – update 2018’, 2nd updated version: Foreword. GMS Infect Dis 2020; 8: Doc20. https://doi.org/10.3205/id000064 Medline, Google Scholar FiguresReferencesRelatedDetails 2 January 2023Volume 32Issue 1ISSN (print): 0969-0700ISSN (online): 2052-2916 Metrics History Published online 11 January 2023 Published in print 2 January 2023 Information© MA Healthcare LimitedPDF download

OBJECTIVE:To internationally validate a tool for predicting the risk of delayed healing of venous leg ulcers (VLUs).METHOD:A 10-item tool including sociodemographic factors, venous history, ulcer and lower limb characteristics, compression and mobility items to determine the risk of delayed healing of VLUs has previously been developed and validated in Australia. This study prospectively validated this tool using receiver operating characteristic (ROC) methods; using the area under the curve (AUC) to quantify the discriminatory capability of the tool to analyse the international populations of the UK, Austria and New Zealand.RESULTS:The validation of the tool in the UK, Austria and New Zealand has indicated that the model has moderate discrimination and goodness-of-fit with an AUC of 0.74 (95% CI: 0.66-0.82) for the total risk assessment score.CONCLUSION:The international validation of a risk assessment tool for delayed healing of VLUs will allow clinicians globally to be able to determine realistic outcomes from an early assessment and to be able to guide early tailored interventions to address the specific modifiable risk factors and thus promote timely healing.

The targeted or universal decolonization of patients through octenidine for nasal treatment and antiseptic body wash for 3 to 5 days prior elective surgery has been implemented in several surgical disciplines in order to significantly reduce surgical site infections (SSIs) caused by Staphylococcus aureus carriage. However, as most healthcare facilities also screen patients on admission for pilot infection, it is imperative that a prophylactic nasal decolonization procedure not yield a false negative SARS-CoV-2 status in otherwise positive patients. We assessed the effect of a commercially available octenidine-containing nasal gel on two different screening methods-antigen (Ag) detection based on colloidal gold immunochromatography and RT-PCR-in a prospective-type accuracy pilot study in asymptomatic SARS-CoV-2-positive inpatients. All patients still showed a positive test result after using the octenidine-containing nasal gel for about 3 days; therefore, its application did not influence SARS-CoV-2 screening, which is of high clinical relevance. Of note is that Ag detection was less sensitive, regardless of the presence of octenidine. From an infection prevention perspective, these results favor octenidine-based decolonization strategies, even during seasonal SARS-CoV-2 periods. As only asymptomatic patients are considered for elective interventions, screening programs based on RT-PCR technology should be preferred.

Background: Cardiac implantable electronic device (CIED) placement comes with certain complications. CIED infection is a severe adverse event related to CIED placement. In randomised controlled trials, the preoperative intravenous administration of antibiotics and the adjunctive use of an antibiotic mesh envelope resulted in significant reduction in infections related to cardiac implantable electronic devices. The adjunctive use of taurolidine for this purpose is relatively novel and not considered in the guidelines. The required evidence may consist of a set of clinical studies. Methods: The European TauroPaceTM registry (ETPR) prospectively evaluates every consecutive invasive procedure involving any CIED with adjunct TauroPace™ use in the contributing centres. As the estimation of the infection rate needs to be defensible, only interventions registered prior to the procedure will be followed-up. The endpoint is a major cardiac implantable electronic device infection according to the novel CIED infection criteria (1). Secondary endpoints comprise all-cause mortality, complications, adverse events of all grades, and major CIED infections during all follow-up examinations. The follow-up times are three months, twelve months, and eventually 36 months, as acute, subacute, and long-term CIED infections are of interest. Results: As the rate of CIED infections is expected to be very low, this registry is a multicentre, international project that will run for several years. Several reports are planned. The analyses will be included in the case number calculations for future randomised controlled trials. Conclusions: The ETPR will accumulate large case numbers to estimate small event rates more precisely; we intend to follow up on participants for years to reveal possible late effects.

BACKGROUND:The risk of a large number of severe acute respiratory infection (SARI) cases emerging is a global concern. SARI can overwhelm the health care capacity and cause several deaths. Therefore, the Austrian Agency for Health and Food Safety will explore the feasibility of implementing an automatic electronically based SARI surveillance system at a tertiary care hospital in Austria as part of the hospital network, initiated by the European Centre for Disease Prevention and Control.OBJECTIVE:We aim to investigate the availability of routinely collected health record data pertaining to respiratory infections and the optimal approach to use such available data for systematic surveillance of SARI in a real-world setting, describe the characteristics of patients with SARI before and after the beginning of the COVID-19 pandemic, and investigate the feasibility of identifying the risk factors for a severe outcome (intensive care unit admission or death) in patients with SARI.METHODS:We will test the feasibility of a surveillance system, as part of a large European network, at a tertiary care hospital in the province of Lower Austria (called Regional Hospital Wiener Neustadt). It will be a cross-sectional study for the inventory of the electronic data records and implementation of automatic data retrieval for the period of January 2019 through the end of December 2022. The analysis will include an exploration of the database structure, descriptive analysis of the general characteristics of the patients with SARI, estimation of the SARI incidence rate, and assessment of the risk factors and different levels of severity of patients with SARI using logistic regression analysis.RESULTS:This will be the first study to assess the feasibility of SARI surveillance at a large 800-bed tertiary care hospital in Austria. It will provide a general overview of the potential for establishing a hospital-based surveillance system for SARI. In addition, if successful, the electronic surveillance will be able to improve the response to early warning signs of new SARI, which will better inform policy makers in strengthening the surveillance system.CONCLUSIONS:The findings will support the expansion of the SARI hospital-based surveillance system to other hospitals in Austria. This network will be of use to Austria in preparing for future pandemics.INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID):PRR1-10.2196/47547.

We report the successful salvage of cardiac implantable electronic device pulse generator protrusion sealed by the surrounding skin in a frail patient presenting 5 months after the last surgical revision. (Level of Difficulty: Advanced.)