High prevalence of asymptomatic bacterial colonization of rhythm management devices

Pichlmaier, Maximilian; Marwitz, Verena; Kühn, Christian; Niehaus, Michael; Klein, Gunnar; Bara, C.; Haverich, Axel; Abraham, Wolf‐Rainer

doi:10.1093/europace/eun191

Cited by 55 publications

(48 citation statements)

References 36 publications

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“…Recent data showed a high rate of asymptomatic bacterial colonization of cardiac devices in subjects who had implants removed for elective reasons: the percentage of bacterial detection ranged from 33% when conventional cultures were performed to 47% when bacterial DNA was evaluated (15,16). To date, there are only two studies that investigated the role of the sonication technique in detecting asymptomatic bacterial colonization (33,34).…”

Section: Discussionmentioning

confidence: 99%

“…Staphylococcal species, including both Staphylococcus aureus and coagulase-negative staphylococci, account for the majority of CDIs (7,9); however, unusual organisms (Propionibacterium spp., Corynebacterium spp., Acinetobacter baumannii, Haemophilus influenzae) are also found, and antibiotic resistance is often detected (10)(11)(12)(13). Moreover, there are data indicating that microorganisms can colonize cardiac devices without clinical signs of active infection (14)(15)(16).…”

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confidence: 99%

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Sonication of Explanted Cardiac Implants Improves Microbial Detection in Cardiac Device Infections

et al. 2013

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The sonication technique has been shown to be a promising tool for microbiological diagnosis of device-related infections. We evaluated the usefulness of the sonication method for pathogen detection in 80 explanted cardiac components collected from 40 patients, and the results were compared with those of conventional cultures. Forty subjects undergoing cardiac device removal were studied: 20 had cardiac device infection, and 20 subjects underwent elective generator replacement or revision in the absence of infection. Sonication of explanted devices was more sensitive than traditional culture for microbial detection (67% and 50%, respectively; P ‫؍‬ 0.0005). The bacterial count detected in sonication fluid culture was significantly higher than that detected in traditional culture in both infected (P ‫؍‬ 0.019) and uninfected (P ‫؍‬ 0.029) devices. In the infected patients, sonication fluid culture yielded a significantly higher rate of pathogen detection in explanted electrodes than traditional culture (65% versus 45%; P ‫؍‬ 0.02), while no differences were found in the generators. Ten strains were detected only through sonication fluid culture: 6 Staphylococcus epidermidis strains, 1 Staphylococcus hominis strain, 2 Corynebacterium striatum strains, and 1 Brevundimonas sp. Neither the type nor the duration of antimicrobial therapy before device removal had an effect on the diagnostic performance of sonication fluid culture (P ‫؍‬ 0.75 and P ‫؍‬ 0.56, respectively). In the patients without infection, sonication fluid culture was positive in 8 cases (40%), whereas conventional culture was positive in only 4 (20%). In summary, the sonication technique improves the microbiological diagnosis of explanted cardiac devices.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Sonication of Explanted Cardiac Implants Improves Microbial Detection in Cardiac Device Infections

et al. 2013

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“…We hypothesize that in vivo abrasions of silicone create a safe location for pathogen accumulation and make washing off by blood flow difficult while further aggravating silicone destruction. Pichlmaier et al 30 and Dy…”

Section: Discussionmentioning

confidence: 99%

Biodegradation of the Outer Silicone Insulation of Endocardial Leads

Kołodzińska

Kutarski

Kozłowska

et al. 2013

Circ: Arrhythmia and Electrophysiology

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Background-Silicone catheter insulation, larynx prostheses undergo biodegradation. The aims of the study were to verify the conviction that outer silicone lead insulation is biostable and inert in addition to determining the role of macrophages (M) and Staphylococcus aureus (S aureus) strains in the silicone lead insulation degradation. Methods and Results-Leads removed from 8 patients because of infective and noninfective indications were analyzed with stereomicroscope and classified according to Banacha abrasion classification, and additional analysis using scanning electron microscope was performed. The examination revealed excavations of different shape and depth in the abraded areas. Fresh silicone-insulated lead was cut into fragments. The fragments were cultured with RAW 264.7 macrophage cell line for 9 weeks. Additional lead fragments were placed with S aureus strains: ATCC 25923, ATCC 29213, and K9328H. Lead fragments were also cocultured with the bacterial strains and RAW M. In scanning electron microscope analysis, diminution in silicone was observed. All S aureus strains provoked insulation damage after 9 weeks. The lowest level of degradation of insulation concerned ATCC 25923. Silicone lead fragments in cocultures presented a further gone level of silicone biodegradation. Conclusions-S aureus, macrophages separately, and S aureus and macrophages cocultures initiate the biodegradation of silicone insulation. Differences in the level of biodegradation between strains of S aureus were observed, with the most aggressive reaction toward silicone visible in the cocultures. In vivo silicone biodegradation is initiated by tearing among surfaces of the lead insulation, macrophages may be the crucial cells for the process that may be aggravated by pathogen colonization. (Circ Arrhythm Electrophysiol. 2013;6:279-286.)Key Words: cardiovasular implantable electronic device infection ◼ endocardial lead abrasion ◼ endocardial lead damage ◼ infective endocarditis ◼ silicone biodegradation

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“…Whether colonization of the devices is a risk factor for subsequent development of clinical infection is an undefined, but a keen area of interest. [82][83][84] Therefore, device culture should not be done unless suspicion for infection is present. 85 Interpretation of TEE results also requires clinical judgment.…”

Section: Diagnostic Evaluationmentioning

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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High prevalence of asymptomatic bacterial colonization of rhythm management devices

Cited by 55 publications

References 36 publications

Sonication of Explanted Cardiac Implants Improves Microbial Detection in Cardiac Device Infections

Sonication of Explanted Cardiac Implants Improves Microbial Detection in Cardiac Device Infections

Biodegradation of the Outer Silicone Insulation of Endocardial Leads

Microbiology and Pathogenesis of Cardiovascular Implantable Electronic Device Infections

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