Contemporary management of cardiovascular implantable electronic device infections

Sohail, M. Rizwan; Sultan, Omer W; Raza, Sania S.

doi:10.1586/eri.10.54

Cited by 17 publications

(12 citation statements)

References 33 publications

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“…71 However, more recent data indicate that the majority of pulmonary emboli are clinically silent and may only be detectable on chest imaging done for other purposes. 80 Laboratory abnormalities are frequent but quite nonspecific in CIED infections. Most commonly encountered abnormal laboratory values include peripheral leukocytosis and anemia.…”

Section: Clinical Manifestationsmentioning

confidence: 99%

Microbiology and Pathogenesis of Cardiovascular Implantable Electronic Device Infections

Nagpal

Baddour

Sohail

2012

Circ: Arrhythmia and Electrophysiology

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A dvancements in our understanding of cardiac conduction abnormalities and pathophysiology of congestive heart failure coupled with innovations in device manufacturing and programming have helped to create a demand for a plethora of newer cardiovascular devices over the past 3 decades. Appropriate use of cardiovascular implantable electronic devices (CIEDs) in carefully selected patients is associated with better survival and significant improvements in quality of life. 1 Cardiac resynchronization therapy devices are the newest "breed" to join an existing and growing family of permanent pacemakers (PPMs) and implantable cardioverterdefibrillators (ICDs). The number of cardiac devices implanted each year continues to grow exponentially. Unfortunately, because of the invasive nature of the implantation procedures required for placement of these devices and multiple comorbid conditions in device recipients, the benefits of these devices can be eclipsed by infectious complications. Infection is a very serious and dreadful complication requiring complete removal of the infected device and systemic antimicrobial therapy. [2][3][4] Moreover, the financial cost of managing device infections is enormous. In this article, we review the latest developments pertaining to CIED infections, with a special emphasis on pathogenesis and microbiology. EpidemiologySince their first conceptualization and use in the late 1950s, 5 CIEDs have undergone significant enhancements in design and function, and their use continues to rise, with a growing number of indications for placement, improvements in implantation techniques, and enhancements in device programming and monitoring. 1 Earlier investigations reported a highly variable CIED infection rate, ranging from 0.13% to 19.9%. 6,7 However, a more recent review of case records from the Massachusetts General Hospital reported 21 (1.2%) ICD-related infections among 1700 patients who underwent device implantation procedures. 8 In a study by Mela et al, 8 CIED infection occurred in 1.8% of 1170 patients who underwent a primary implant, a generator change, or a revision of their systems. In a population-based study from Olmstead County, Minnesota, the estimated rate of CIED infections was 1.9 per 1000 device-years. 9 Interestingly, the cumulative probability of device infection in this study was higher among patients with ICDs than in those with PPMs, 9 an observation that has also been reported by other investigators. 10 Contrary to expectations that increasing sophistication in device manufacturing and implantation techniques, coupled with higher volumes of implantation and more experience, will lead to a reduction in the CIED infection rate, recent data from large database surveys suggest that the rate of infectious complications has been rising out of proportion with the rate of CIED implantations. According to National Hospital Discharge Survey 10 data from 1996 to 2003, 180 284 PPMs and 57 436 ICDs were placed in 2003, representing a 49% increase in the number of implants during the s...

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Section: Clinical Manifestationsmentioning

confidence: 99%

Microbiology and Pathogenesis of Cardiovascular Implantable Electronic Device Infections

Nagpal

Baddour

Sohail

2012

Circ: Arrhythmia and Electrophysiology

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“…Fungi other than Candida and nontuberculosis mycobacteria are rarely responsible for CIED infection (Sohail et al, 2010). The microorganisms that cause CIED infections may be acquired either endogenously from the skin of patients or exogenously from the hospital environment.…”

Section: Etiologymentioning

confidence: 99%

Infections of Cardiac Implantable Electronic Devices: Etiology, Prevention and Treatment

Chelazzi¹,

Selmi²,

Vitali³

et al. 2011

Aspects of Pacemakers - Functions and Interactions in Cardiac and Non-Cardiac Indications

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“…In mild cases such as superficial incision site infection or stitch abscess, conservative management strategies may suffice, such as 7-10 days of antimicrobial therapy and removal of the stitches. 40 When CIED infection is restricted to the pocket site, an American Heart Association (AHA) scientific statement recommends 7-10 days of therapy after device removal if no inflammatory changes are seen, otherwise 10-14 days of antimicrobial treatment is recommended. 28 At least one of the authors would extend the treatment until complete wound healing.…”

Section: Management Of Cardiac Implantable Electronic Device Infectionmentioning

confidence: 99%

Cardiac Implantable Electronic Device Infection in Patients at Risk

Tarakji

Ellis

Defaye

et al. 2016

Arrhythmia &Amp; Electrophysiology Review

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Device TherapyOver the last few decades an increasing body of evidence has supported the role of cardiovascular implantable electronic devices However, the cost and complications of device implantation, including infection or hardware malfunction in patients receiving CIEDs, have led to the concern that negative outcomes may partially counteract the expected benefits. The rate of CIED infection has been estimated at 0.5 % with primary implants and 1-7 % with secondary interventions.3,5-8 It is difficult to give accurate estimates of infection rates, given the fact that figures are partly based on retrospective series of varying duration, and that different definitions of infection exist. However, the incidence of CIED infection is increasing out of proportion to CIED implantation. 3,5,9 A US study reported a 12 % increase in the number of CIED implantations from 2004 to 2006, with a 57 % increment in CIED infections during the same period. 9Reasons for this rise in CIED infections include the fact that younger patients are receiving CIEDs, and therefore surviving long enough to require more pulse generator changes and lead revisions, which are associated with a higher infection rate. 7,10 In addition, there has been an increase in comorbidities, such as diabetes and kidney disease, resulting in poor wound healing and diminished immune responses. 3,9,11,12 Expanding indications for CIED use, coupled with an ageing population with more comorbidities, mean this trend is likely to increase.2 Better awareness and improved reporting of CIED infections may, however, help to decrease the higher complication rates noted in recent years.CIED infections also impose a substantial financial burden resulting from prolonged hospital stays, long duration of antibiotic therapy, management of sepsis and complications, device extraction and reimplantation.3 These infections typically cost at least $52,000 13 and may exceed $100,000. 14 This article will review strategies for management and prevention of CIED infections, including lead extraction and the use of an absorbable antibacterial envelope. Risk Factors for Cardiac Implantable Electronic Device Infections

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Contemporary management of cardiovascular implantable electronic device infections

Cited by 17 publications

References 33 publications

Microbiology and Pathogenesis of Cardiovascular Implantable Electronic Device Infections

Microbiology and Pathogenesis of Cardiovascular Implantable Electronic Device Infections

Infections of Cardiac Implantable Electronic Devices: Etiology, Prevention and Treatment

Cardiac Implantable Electronic Device Infection in Patients at Risk

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