Cardiovascular Implantable Electronic Device Replacement Infections and Prevention: Results from the REPLACE Registry

Uslan, Daniel Z.; Gleva, Marye J.; Warren, David K.; Mela, Theofanie; Chung, Mina K.; Gottipaty, Venkateshwar; Borge, Richard; Dan, Dan; Shinn, Timothy; Mitchell, Kevin; Holcomb, Richard; Poole, Jeanne E.

doi:10.1111/j.1540-8159.2011.03257.x

Cited by 143 publications

(111 citation statements)

References 22 publications

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“…Use of chlorhexidinealcohol as an antiseptic reduces surgical site infections compared with povidone-iodine in clean surgery. 36,38,39 This effect is thought to be related to a faster and more persistent activity despite exposure to bodily fluids during surgery. Use of transparent films, diathermia or substances to prevent bleeding have not proven beneficial.…”

Section: Peri-operativementioning

confidence: 99%

“…Fever within 24 hours before implant is associated with a 5-6 fold infection risk, and diagnosis and treatment of ongoing infection before implantation is therefore important. 36 It is unsettled whether infected patients who need acute cardiac pacing are best managed with initial temporary transvenous pacing or primary permanent CIED implantation. In most cases, temporary pacing is chosen; however, presence of a temporary pacing lead is also associated with a higher infection risk.…”

Section: Before Implantationmentioning

confidence: 99%

“…evaluation of indication for CIED implantation including appropriate type of CIED) is essential with assessment of risks and benefits, accounting for individual patient characteristics and comorbidities. 36 Several patient-related factors are associated with heightened risk of CIED infection, such as age, gender, renal failure, diabetes, respiratory failure, corticosteroid treatment, chronic skin conditions and higher comorbidity index (see Table 1). Since these conditions are largely unavoidable, attention should focus on optimisation before CIED implantation.…”

Section: Before Implantationmentioning

confidence: 99%

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Management of Cardiac Electronic Device Infections: Challenges and Outcomes

Kirkfeldt¹,

Johansen²,

Nielsen³

2016

Arrhythmia &Amp; Electrophysiology Review

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Cardiac implantable electronic device (CIED) infection is an increasing problem. Reasons for this are uncertain, but likely relate to an increasing proportion of implantable cardioverter defibrillator (ICD) and cardiac resynchronisation therapy (CRT) devices implanted, as well as implantations in ‘higher risk’ candidates, i.e. patients with heart failure, diabetes and renal failure. Challenges within the field of CIED infections are multiple with prevention being the most important challenge. Careful prescription of CIED treatment and careful patient preparation before implantation is important. Diagnosis is often difficult and delayed by subtle signs of infection. Treatment of CIED infection includes complete system removal in centres experienced in CIED extraction and prolonged antibiotic therapy. Meticulous planning and preparation before system extraction and later CIED re-implantation is essential for better patient outcome. Future strategies for reducing CIED infection should be tested in sufficiently powered, multicentre, randomised controlled trials

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Section: Peri-operativementioning

confidence: 99%

Section: Before Implantationmentioning

confidence: 99%

Section: Before Implantationmentioning

confidence: 99%

See 1 more Smart Citation

Management of Cardiac Electronic Device Infections: Challenges and Outcomes

Kirkfeldt¹,

Johansen²,

Nielsen³

2016

Arrhythmia &Amp; Electrophysiology Review

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“…Specifically, 1‐year follow‐up results from the Bridge or Continue Coumadin for Device Surgery Randomized Controlled Trial (BRUISE CONTROL) showed that the risk of device infection was more than 7‐fold greater among patients with clinically significant pocket hematoma versus those without ( P <0.001) 14. Further, results from BRUISE CONTROL advanced the literature beyond previously inconsistent findings on the association between hematoma and infection 15, 16, 17, 18, 19…”

Section: Introductionmentioning

confidence: 96%

Incidence of Bleeding‐Related Complications During Primary Implantation and Replacement of Cardiac Implantable Electronic Devices

Nichols

Vose

2017

JAHA

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BackgroundUse of cardiac implantable electronic devices (CIEDs) is increasing. The incidence of bleeding‐related complications during CIED procedures and the association with subsequent infection risk have been studied in trial settings but not in nonrandomized “real‐world” populations.Methods and ResultsThis retrospective database analysis of US insurance claims from the Truven MarketScan database (2009‐2013) evaluated the incidence of bleeding complications during, or in the 30 days following, a CIED procedure and the association between bleeding and subsequent infection in days 31 to 365 of follow‐up. This study identified 42 606 patients who had a primary or replacement CIED procedure and met all inclusion criteria. Incidence of bleeding ranged from 0.58% to 2.81% by type of pharmaceutical therapy. Incidence of infection during days 31 to 365 of follow‐up was significantly higher among patients with a bleeding complication in the first 30 days versus those without (6.56% vs 1.24%, P<0.001), with results upheld in multivariate analysis (HR=2.97, 95% CI 1.94‐4.54, P<0.001).ConclusionsThis study provides a lower bound of the real‐world incidence of bleeding complications following a CIED procedure within the coding limitations of an insurance claims database. Results confirm the association between bleeding in the pocket and risk of subsequent infection. Further research is needed to precisely identify the costs associated with bleeding in the pocket.

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“…4 With no evidence documenting its efficacy, administration of post-operative antibiotic therapy is not recommended due to its potential association with adverse side-effects and selection of drug resistant organisms. 4,8 Recently a new technique to reduce surgical site infections was proposed. The CIED is implanted within an antibacterial polypropylene mesh sleeve that releases minocycline and rifampicin in the generator Prospective registries are ongoing and randomised studies are warranted to validate routine use of this promising prophylactic tool.…”

Section: Treatment and Preventionmentioning

confidence: 99%

Management of Cardiac Implantable Electronic Device Infection

Podoleanu

Deharo

2014

Arrhythm Electrophysiol Rev

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The increasing use of cardiac implantable electronic devices (CIEDs) for management of cardiac conditions has over the last few years been associated with higher infection rates.1 Expanded CIED use alone cannot account for this rise, 2-4 which involves both patient-and device-related factors. Indeed patients are tending to be older and presenting with co-morbidities, while devices are becoming more sophisticated and requiring more leads and revision. 6 In terms of patient demographics, the occurrence of CIED infection was greatest in white males over 65 years of age, and the most significant associated co-morbidities were renal failure, respiratory failure, heart failure and diabetes. The greatest risk factors for mortality were respiratory failure (odds ratio [OR] 13.58; 95 % confidence interval [CI] 12.88-14.3), renal failure (OR 4.28; 95 % CI 4.04-4.53) and heart failure (OR 2.71; 95 % CI 2.54-2.88). Post-operative haematoma was more frequent in patients who developed infection. Sites reporting higher infection rates had sicker patients and lower overall procedure volumes. AbstractDespite improved preventive measures, infection associated with the use of cardiac implantable electronic devices (CIEDs) to treat often life-threatening conditions is rising at an average annual rate of almost 5 %. This rise is being driven by the increasing complexity of CIED technology and by the advancing age and co-morbidities of the patients. Although CIED infection is usually suspected based on local signs at the generator pocket site, diagnosis can be challenging in patients presenting no local manifestations or symptoms. Diagnostic methods include microbiological testing and echocardiography, and may be completed by positron emission tomography (PET)/computed tomography (CT) scan in selected cases. CIED infection requires a multidisciplinary approach in view of hardware extraction, targeted antibiotic therapy and reimplantation on an as-needed basis. Antibiotic prophylaxis targeting staphylococcal flora is recommended but the relation of these infections to medical care exposes patients to multi-resistant bacteria. New preventive measures utilising an antibacterial sleeve look promising. Treatment can be started on an empirical basis using an antistaphylococcal agent but must be continued using targeted antibiotic therapy. Crucial questions remain as to the best prevention strategy, optimal duration and timing of antibiotic therapy, and the most effective reimplantation technique.

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Cardiovascular Implantable Electronic Device Replacement Infections and Prevention: Results from the REPLACE Registry

Cited by 143 publications

References 22 publications

Management of Cardiac Electronic Device Infections: Challenges and Outcomes

Management of Cardiac Electronic Device Infections: Challenges and Outcomes

Incidence of Bleeding‐Related Complications During Primary Implantation and Replacement of Cardiac Implantable Electronic Devices

Management of Cardiac Implantable Electronic Device Infection

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