Cardiac Implantable Electronic Device Infections; Long-Term Outcome after Extraction and Antibiotic Treatment

Abstract

Background: The aim of the study was to examine the treatment outcome for patients with cardiovascular implantable electronic device (CIED) infections after extraction. Methods: Patients who underwent CIED extractions due to an infection at Karolinska University Hospital 2006–2015 were analyzed. Results: In total, 165 patients were reviewed, 104 (63%) with pocket infection and 61 (37%) with systemic infection. Of the patients with systemic infection, 34 and 25 patients fulfilled the criteria for definite and possible endocarditis, respectively. Complications after extraction occurred only in one patient. Reimplantation was made after a mean of 9.5 days and performed in 81% of those with pocket infection and 44.3% in systemic infection. Infection with the new device occurred in 4.6%. The mean length of hospital stay for patients with pocket infection was 5.7 days, compared to 38.6 days in systemic infection. One-year mortality was 7.7% and 22.2% in pocket infection and systemic infection, respectively. Patients with Staphylococcus aureus infection had a higher mortality. Conclusions: In this study, the majority of the patients had a pocket CIED infection, with a short hospital stay. Patients with a systemic infection, and S. aureus etiology, had a prolonged hospital stay and a higher mortality.

Mortality after transvenous lead extraction: A risk prediction model for sustainable care delivery

“…The largest ‘real‐word’ prospective registry confirmed both ‘acute’ safety and efficacy of TLE, with a complete clinical success of 96.7% and all cause in‐hospital deaths of 1.2% in high volume centres 2 . Nonetheless, evidences on long‐term mortality after TLE are still scarce, as described by recent studies focused on ‘CIED infection’‐related predictors of long‐term outcomes after TLE 8–15 …”

“…Nonetheless, literature about the long‐term follow‐up of patients undergoing TLE is still lacking. In particular, short‐term safety and efficacy of TLE have been extensively investigated, 2,6,7 while reports on very long‐term outcomes after TLE are still limited and particularly focused on infection‐related predictors of mortality 8–15 . Moreover, there is evidence in the scientific literature of substantial costs associated with extraction and reimplantation procedures 16 .…”

“…In particular, short-term safety and efficacy of TLE have been extensively investigated, 2,6,7 while reports on very long-term outcomes after TLE are still limited and particularly focused on infection-related predictors of mortality. [8][9][10][11][12][13][14][15] Moreover, there is evidence in the scientific literature of substantial costs associated with extraction and reimplantation procedures. 16 Given these knowledge gaps, the aim of our study was to provide a careful analysis of very long-term mortality from a single high-volume tertiary referral centre for TLE, in a public health perspective, with regard to the sustainability of TLE procedure and clinical follow-up.…”

Predictors of long-term mortality after transvenous lead extraction of an infected cardiac device: a risk prediction model for sustainable care delivery.

“…The largest "real-word" prospective registry confirmed both "acute" safety and efficacy of TLE, with a complete clinical success of 96.7% and all cause inhospital deaths of 1.2% in high volume centres (2). Nonetheless, evidences on long-term mortality after TLE are still scarce, as described by recent studies focused on "CIED infection"-related predictors of long-term outcomes after TLE (8)(9)(10)(11)(12)(13)(14)(15).…”

“…Nonetheless, literature about the long-term follow-up of patients undergoing TLE is still lacking. In particular, short-term safety and efficacy of TLE have been extensively investigated (2,6,7), while reports on very long-term outcomes after TLE are still limited and particularly focused on infection-related predictors of mortality (8)(9)(10)(11)(12)(13)(14)(15). Moreover, there is evidence in the scientific literature of substantial costs associated with extraction and reimplantion procedures (16).…”