Contemporary management of and outcomes from cardiac device related infections

Margey, Ronan; McCann, Hugh A.; Blake, Gavin J.; Keelan, Edward; Galvin, Joseph; Lynch, Maureen; Mahon, Niall; Sugrue, D.; O’Neill, James

doi:10.1093/europace/eup362

Cited by 153 publications

(150 citation statements)

References 21 publications

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“…A series without complete device removal have shown that over half of patients demonstrate relapse. 10,68,69 In a recent study, it was found that the rate of CIED infection after CIED extraction was higher in patients with incomplete lead removal, 13.5 % versus 3.0 %. 70 In addition, mortality appears higher without complete removal.…”

Section: Outcomes Of Cardiac Implantable Electronic Device Infectionmentioning

confidence: 99%

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: Outcomes Of Cardiac Implantable Electronic Device Infectionmentioning

confidence: 99%

Management of Cardiac Electronic Device Infections: Challenges and Outcomes

Kirkfeldt¹,

Johansen²,

Nielsen³

2016

Arrhythmia &Amp; Electrophysiology Review

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“…It is extremely important to confirm LRIE in order to initiate adequate therapy, as in patients with this insidious entity, long-term had positive cultures from leads explanted transvenously through the infected pocket, although pocket cultures were negative, and vice versa, there were negative cultures from leads extracted transvenously through the pocket which was culture-positive (15%). 10 The Polish TLE registry provided similar data (1801 patients, including 746 with CDI): 11% of positive lead cultures were obtained from patients with the symptoms of PI, although pocket cultures were negative; 16.7% of negative lead cultures were concomitant with positive pocket cultures (unpublished data). In view of the low rate of discordance, positive lead cultures should be regarded as very helpful in the diagnosis of LRIE.…”

mentioning

confidence: 87%

Cardiac device infections: definition, classification, differential diagnosis, and management

Polewczyk¹,

Janion²,

Kutarski³

2016

Polish Archives of Internal Medicine

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275an ICD, and especially with a CRT-D, no such disproportions have been reported in other studies. The Dutch device registry including over 3000 patients with 1200 PMs, 1414 ICDs, and 795 CRT-Ds implanted between 2000 and 2007, did not show any differences in the development of CDIs between different pacing systems.6 Between 2006 and 2015, we conducted a single-center registry study including 1801 patients undergoing transvenous lead extraction (TLE) (1266 PMs, 385 ICDs, and 150 CRT-Ds). The registry showed a lower incidence of infectious complications in patients with ICDs than in those with PMs (35.8% vs 42.2%; P = 0.009), whereas the highest rate of infections was found in patients with CRT-Ds, namely, 51.3% of patients with CDI-associated TLE (unpublished data).Classification of cardiac device infections CDIs still pose a serious clinical problem. Varying terminology and different CDI classifications are one of the major diagnostic and therapeutic challenges that are encountered in routine clinical practice. The problem arises during an attempt to estimate Introduction The era of cardiac pacing began in the 1960s. Since then, the use of pacemakers (PMs) has increased rapidly and now includes traditional PMs, implantable cardioverter--defibrillators (ICDs), and cardiac resynchronization therapy devices (CRT-Ds). Unfortunately, the progress in pacing therapy is associated with the development of infections, which constitute an increasing clinical challenge and reduce positive effects of treatment. At present, the incidence of cardiac device infections (CDIs) in patients with implantable cardiac electronic devices (ICEDs) is estimated to range from 0.5% to 2.2%; however, the exact incidence is difficult to assess because different studies use different methodologies.1 Some investigators addressed the problem of CDIs in device-years, reporting an incidence of 1.8 to 1.9 per 1000 PM years and 3.1 to 10 per 1000 PM years for ICD and CRT-D, respectively 2-5 ; however, studies comparing the incidence of CDIs in patients with ICEDs have provided conflicting results.Apart from the above data showing a significantly higher incidence of CDIs in patients with ABSTRACTCardiac device infections (CDIs) continue to be a serious clinical problem, with varying terminology and different classifications constituting one of the major diagnostic and therapeutic challenges in routine clinical practice. The problem invariably arises during an attempt to estimate the extent of the infection, which in consequence determines the choice of treatment strategy (duration of antibiotic therapy). The most serious form of CDI is lead-related infective endocarditis (LRIE). There are no clearly established diagnostic criteria for this disease; the available Duke University criteria are difficult to apply in patients with a suspicion of LRIE because of low sensitivity. As the treatment of LRIE is expensive and troublesome, there is a tendency to underdiagnose this condition and seek any intermediary forms between local pocket infection and def...

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“…The time of onset of the infection is extremely variable. Margey et al (2010) reported a median duration from device implant or revision to presentation with confirmed cardiac device infection of 150 days (range 5-2920 days, with an interquartile 25% of 35 days and an interquartile 75% of 731 days). Fever, chills and malaise were the most common presenting symptoms.…”

Section: Complications Of Pacemaker Implantation 273mentioning

confidence: 99%

“…Microbiological findings. It is not always possible to define the agent of infection: in a very recent report (Margey et al, 2010) out of 39 cardiac device infection cases, a causative organism was identified only in 62%. The most frequent causative organism was methicillin sensitive Staphyloccoccus aureus (30.8%), followed by coagulase negative Staphylococcus (20.5%), and Streptococcus species (7.7%).…”

Section: Complications Of Pacemaker Implantation 273mentioning

confidence: 99%

“…Cardiac ultrasound does not seem to have an high diagnostic sensitivity. In the Margey et al (2010) series 87% of the patients underwent transthoracic echocardiography during their admission and 36% also underwent transoesophageal echocardiography. In those in whom echocardiography was performed, vegetations were identified on the lead in 18%, and involving the heart valves in 5%.…”

Section: Complications Of Pacemaker Implantation 273mentioning

confidence: 99%

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