Can implantable cardiac electronic device infections be defined as ‘early’ or ‘late’ based on the cause of infection?

Abstract

Implantable cardiac electronic device (ICED) infections are a major cause of morbidity and mortality. Understanding the pathogenesis of these infections is important in their prevention and management. We hypothesized that ICED infections could be classified as 'early' or 'late', based on differences in microbiological cause within or beyond 1 year of implantation, respectively. A comprehensive review of the literature was undertaken to test this hypothesis. Prosthetic valve endocarditis cases were included for comparison. Articles were included if the time from device implantation to infection, definite evidence of infection (pocket/bacteraemia/endocarditis) and a positive microbiological diagnosis were included. There were no statistically significant differences in microbiology to support a 1 year cut-off between early and late ICED infection. Staphylococcus aureus and coagulase-negative staphylococci were the predominant causes of ICED infection both within and beyond 1 year of ICED implantation. To further assess the microbiological causes of ICEDs and their implications for pathogenesis a large-scale multicentre study is required.

Clinical and Microbiological Characterization of Late Breast Implant Infections after Reconstructive Breast Cancer Surgery

“…The relatively low prevalence of MRSA is in agreement with data from late orthopedic prosthetic infections [31], and with their lower prevalence in late (as compared with early) implantable cardiac device infections [32]. The frequency of MRSE in the present work is in line with findings from late implant infections in cardiac and orthopedic surgery series [32][33][34]. Although methicillin resistance is increasing in the community, healthcare-associated acquisition of these pathogens cannot be completely ruled out here during repeated postsurgical outpatient visits in patients who may need chemotherapy or expander inflation.…”

Microbial diagnosis of infection and colonization of cardiac implantable electronic devices by use of sonication

“…6,13,16 Classically, Gram-positive bacteria (both CoNS and S. aureus) have been by far the most common pathogens isolated in CIDAIs. 5,30 Not surprisingly in the present study, sonication fluid cultures of explanted CIEDs yielded mainly Gram-positive cocci (69.5%), mostly CoNS, followed by Streptococcus spp and S. aureus; however, other biofilm-forming pathogens such as S. maltophilia, Corynebacterium sp, A. baumannii, Pseudomonas sp, and Candida sp were also identified. Conversely, among the infected subjects with positive cultures (including two cases of endocarditis-associated CIED), the spectrum of microorganisms identified was different from that reported by other authors, in which half of the bacteria isolated were Gram-negative bacilli, suggesting a strong influence of previous antibiotic intake on the skin flora prior to device removal.…”

“…Furthermore, subjects presenting late infections are likely to present with non-staphylococcal organisms that may be less frequently diagnosed in pocket infection. [24][25]30 Asymptomatic bacterial colonization due to biofilm formation on the surface of CIEDs has been defined as a risk factor for CIDAI, with rates varying from 21% to 27% when phenotypic methods of investigation were applied. 13,16 Nevertheless, authors using molecular biology methods were more successful in identifying microorganisms colonizing uninfected CIEDs, with rates ranging from 38.5% to 47.2%.…”

Differences of Mortality Rates between Pocket and Nonpocket Cardiovascular Implantable Electronic Device Infections

“…Clear‐cut categories of CIED‐related infections are hard to define given the lack of uniform case definitions and significant overlap of symptoms and clinical findings between groups. Other investigators have looked at the existing published data and tried to divide cases into either “early” or “late” infections using a 1‐year cutoff with disappointing results . Here we classified infections into four categories based on pathophysiology.…”

“…Cardiovascular implantable electronic devices (CIEDs) are indispensable tools in today's medicine. While of proven benefit, they can be associated with serious complications, notably infections . In prospective studies, infection rates after CIED implantation have ranged between 0.5% and 2.6% and roughly 30,000 new cases are seen annually in the United States alone …”