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

Chelazzi, Cosimo; Selmi, Valentina; Vitali, Luca; Gaudio, Angelo Raffaele De

doi:10.5772/23360

Cited by 3 publications

(3 citation statements)

References 39 publications

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“… 22 Another important risk factor is the number of leads, as it has been reported in another study that implantation of two or more leads is considered an independent risk factor for CIED infections. 24 Our study supports this as a risk factor since the majority of our infected patients had more than one lead: 6 (26%) with two leads, 8 (34.7%) with three leads and only 9 (39.1%) with one lead.…”

Section: Discussionsupporting

confidence: 83%

Retrospective study of post-operative infections in implantable cardiac devices in a cardiac tertiary care center

et al. 2022

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BACKGROUND: The rise in the incidence of implantation is one of the main causes behind the increased rate of CIED infection, which is considered as a serious life-threatening complication. The need of risk factor assessment has become a necessity to prevent further complications and provide prompt management. OBJECTIVES: Identify the risk factors of infection postoperatively among patients who have implantable cardiac devices. DESIGN: A retrospective case-control study. SETTINGS: Cardiac center for adults. PATIENTS AND METHODS: The study included all adult patients (≥14 years of age) of all nationalities who underwent cardiac electronic device implantation that was managed in the cardiac center between January 2012 to December 2018. MAIN OUTCOME MEASURES: Cardiac device infection and associated risk factors. SAMPLE SIZE: 213, including 23 (10.8%) infected case patients and 190 (89.2%) non-infected controls. RESULTS: The mean (SD) age of non-infected patients was 45.0 (12.7) years compared with 61.7 (13.7) for infected patients (P<.0001). Anticoagulant use, hypertension, dysplipdemia and age were the most common patient-related risk factors associated with infection. For procedural and post-procedural risk factors, the risk of infection increased as the number of leads and length of procedure increased. The device most often related to infection was the pacemaker. In the multivariate analysis, longer procedure, greater number of leads, older age, anticoagulant use, and implanted pacemaker device were independently associated with infection. CONCLUSION: We advise the prompt use of strict preoperative antiseptic prophylaxis measures and follow-up for post-implant patients along with patient education for early signs of infections, which will lead to improvement of both diagnosis and treatment quality for our patients in addition to reducing the economic impact on the health care system by minimizing infectious complications. LIMITATIONS: Single tertiary center study, small sample size. CONFLICT OF INTEREST: None.

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Section: Discussionsupporting

confidence: 83%

Retrospective study of post-operative infections in implantable cardiac devices in a cardiac tertiary care center

et al. 2022

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“…Fifty-four of these patients were excluded from the present analysis because they had permanent cardiac devices, a condition that might introduce confounding factors linked to the different mechanism of infection (9). Therefore, the population for the present work included the remaining 131 patients (45 women and 86 men; mean age 6 SD, 62.8 6 16.6 y) in whom IE was suspected or established as definite according to the Duke criteria; in the latter case, scintigraphy was performed to exclude septic embolism.…”

Section: Patient Populationmentioning

confidence: 99%

Added Value of ^99mTc-HMPAO–Labeled Leukocyte SPECT/CT in the Characterization and Management of Patients with Infectious Endocarditis

Erba¹,

Conti²,

Lazzeri³

et al. 2012

J Nucl Med

213

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The clinical performance of the Duke Endocarditis Service criteria to establish the diagnosis of infectious endocarditis (IE) can be improved through functional imaging procedures such as radiolabeled leukocytes ( 99m Tc-hexamethylpropyleneamine oxime [HMPAO]-labeled white blood cells [WBC]). Methods: We assessed the value of 99m Tc-HMPAO-WBC scintigraphy including SPECT/CT acquisitions in a series of 131 consecutive patients with suspected IE. Patients with permanent cardiac devices were excluded. 99m Tc-HMPAO-WBC scintigraphy results were correlated with transthoracic or transesophageal echocardiography, blood cultures, and the Duke criteria. Results: Scintigraphy was true-positive in 46 of 51 and false-negative in 5 of 51 cases (90% sensitivity, 94% negative predictive value, and 100% specificity and positive predictive value). No false-positive results were found, even in patients with early IE evaluated within the first 2 mo from the surgical procedure. In 24 of 51 patients with IE, we also found extracardiac uptake, indicating septic embolism in 21 of 24. Despite the fact that septic embolism was found in 11 of 18 cases of Duke-definite IE, most of the added value from the 99m Tc-HMPAO-WBC scan for decision making was seen in patients in whom the Duke criteria yielded possible IE. The scan was particularly valuable in patients with negative or difficult-to-interpret echocardiographic findings because it correctly classified 11 of 88 of these patients as having IE. Furthermore, 3 patients were falsely positive at echocardiography but correctly negative at 99m Tc-HMPAO-WBC scintigraphy: these patients had marantic vegetations. Conclusion: Our results demonstrate the ability of 99m Tc-HMPAO-WBC scintigraphy to reduce the rate of misdiagnosed cases of IE when combined with standard diagnostic tests in several situations: when clinical suspicion is high but echocardiographic findings are inconclusive; when there is a need for differential diagnosis between septic and sterile vegetations detected at echocardiography; when echocardiographic, laboratory, and clinical data are contradictory; and when valve involvement (especially of a prosthetic valve) needs to be excluded during febrile episodes, sepsis, or postsurgical infections.

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“…The patient management should include bacterial and fungal infection coverage. Also the infected device must be removed with the reinsertion of the new device to be inserted through an uninfected route [2].…”

Section: Managementmentioning

confidence: 99%

Case Report of Protruded Implantable Cardiac Device through Chest in 50 Years Old Male

2023

COA

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Background: Implantable cardiac defibrillators use has been increasing for the last two decades and they are prone to infections. ICD device infection risk factors are many, some are host related while the others are procedures related. Staphylococcus aureus and staphylococcus epidermidis are accountable for 65 to 75% of the total cases of Implantable cardiac devices infections. Case Presentation: A 50 years old male presented to our emergency department with ICD pocket migrated through the skin. The symptoms started over 2 weeks, started as gradual feeling of foreign body moving underneath the skin, associated with mild pain and 3 days before presentation, the ICD penetrated the skin. The patient denied any history of fever, bleeding, pus discharge, palpitations, abnormal shocks or syncope. He was admitted to the hospital, treated for a presumed infection and his ICD device was removed. Conclusion: ICD devices complications are many, including infections. But, to have an infected device protruded through the skin is not a common presentation. We outlined the approach that was taken for this patient and his management in order to enhance the literature in terms of the above mentioned rare presentation.

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

Cited by 3 publications

References 39 publications

Retrospective study of post-operative infections in implantable cardiac devices in a cardiac tertiary care center

Retrospective study of post-operative infections in implantable cardiac devices in a cardiac tertiary care center

Added Value of ^99mTc-HMPAO–Labeled Leukocyte SPECT/CT in the Characterization and Management of Patients with Infectious Endocarditis

Case Report of Protruded Implantable Cardiac Device through Chest in 50 Years Old Male

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

Cited by 3 publications

References 39 publications

Retrospective study of post-operative infections in implantable cardiac devices in a cardiac tertiary care center

Retrospective study of post-operative infections in implantable cardiac devices in a cardiac tertiary care center

Added Value of 99mTc-HMPAO–Labeled Leukocyte SPECT/CT in the Characterization and Management of Patients with Infectious Endocarditis

Case Report of Protruded Implantable Cardiac Device through Chest in 50 Years Old Male

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Added Value of ^99mTc-HMPAO–Labeled Leukocyte SPECT/CT in the Characterization and Management of Patients with Infectious Endocarditis