Cardiac Implantable Electronic Device Infection: From an Infection Prevention Perspective

Abstract

A cardiac implantable electronic device (CIED) is indicated for patients with severely reduced ejection fraction or with life-threatening cardiac arrhythmias. Infection related to a CIED is one of the most feared complications of this life-saving device. The rate of CIED infection has been estimated to be between 2 and 25; though evidence shows that this rate continues to rise with increasing expenditure to the patient as well as healthcare systems. Multiple risk factors have been attributed to the increased rates of CIED infection and host comorbidities as well as procedure related risks. Infection prevention efforts are being developed as defined bundles in numerous hospitals around the country given the increased morbidity and mortality from CIED related infections. This paper aims at reviewing the various infection prevention measures employed at hospitals and also highlights the areas that have relatively less established evidence for efficacy.

New Insights into Predictors of Cardiac Implantable Electronic Device Infection

“…Before a procedure, a glyco sylated hemoglobin level of <7% is recommended, and the morning after the procedure, the target blood glucose level is <180 mg/dL. 25 In our study population, moderate-to-severe renal dysfunction (GFR, <60 mL/min/1.73 m 2 ) significantly increased the risk of infection after a CIED procedure (P=0.009), and similar results have been documented in previous studies. 8,26 The heightened risk of infection is related to uremia-induced immunodeficiency, bacteremia due to repeated intravenous access, associated comorbidities, and elevated risks of bleeding and pocket hematoma.…”

Evaluation of local action of biological case in the model of infection of the pacemaker pocket in experiment on large laboratory animal

“…Инфекции, ассоциированные с СИЭУ, связаны с повышенной заболеваемостью, летальностью и расходами на лечение. Частота инфекций CИЭУ значительно превышает частоту инфекций в месте хирургических вмешательств в чистой ране (2-4 против 1%) [2,7,10]. Заражения устройств развиваются чаще, чем инфекции при других имплантах, например при протезировании коленного и тазобедренного суставов [7].…”

“…Новым направлением в профилактике инфекции СИЭУ является использование антибактериального конверта, в который укладывается устройство перед помещением в ложе. В настоящее время за рубежом доступны две версии: неабсорбируемый и абсорбируемый конверт TYRX (Medtronic Inc., США) и конверт CorMatrix CanGaroo (CorMatrix Cardiovascular, США) [2,[4][5][6][7]. Конверт TYRX последнего поколения выполнен из биоабсорбируемой мультифиламентной сетки, выделяющей антимикробные агенты (миноциклин и рифампицин) в течение не менее чем 7 дней, а затем полностью рассасывающейся примерно через 9 нед после имплантации.…”

Treatment of Infected Cardiac Implantable Electronic Devices

“…7 Topkara et al report a pacemaker infection rate of between 13% and 80%; however, others estimate it to be between 2% and 4% with rates rising 124% between years 1990 to 1999 and a 57% rise from 2004 to 2006, respectively. 8,9 Similarly, infection rates related to LVAD placement demonstrate a large range of between 13% and 80% among recipients. 10 This wide variability in infection risk is in part due to different types of infections that have been included under the category of CIED-related infections.…”

“…Patients of advanced age, with congestive heart failure, with a metastatic malignancy, on corticosteroid therapy, or with renal failure are more likely to develop CIED infections thereby increasing their mortality. 9 …”