Infections of cardiac rhythm devices, such as pacemakers and defibrillators have seen a steady worldwide increase. In the past, high rates of infection recurrence and mortality with antibiotic-only treatment prompted the expert recommendation that all infections be managed by device and lead removal and replacement. In certain patients, however, device removal is risky and costly, leading to a reexamination of conservative treatment in these patients. We present a case series of nine patients treated by intravenous antibiotics coupled with antibiotic solution wound irrigation and lavage. The mean period of follow-up was 25 months, ranging from six to 60 months. At last follow-up, all patients remained infection-free and were still alive. This report is the first of its kind in the Caribbean region and a valuable addition to the literature on alternatives to device removal, especially in resource-constricted settings, and may be applied successfully to patients who present early with infections localized to the pocket.
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