Op-041 Incidence and Management of Bacterial Endocarditis in Patients With Infected Cardiac Devices

Andraos, A; Tayeh, Osama; Hussein, Khald; Aly, Randa; Azab, Abdo El; Khald, Hassan; Muneretto, Claudio

doi:10.1016/s0167-5273(10)70043-7

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“…The risk of infection in diabetic patients may be a consequence of the chronic hyperglycemia immunosuppressive impact. This finding is similar to the previous study done by the same department, which shows no statistically significant difference in the frequency of diabetes mellitus between the PI and endocarditis groups [9]. Similar results have been reported in other studies stating the high prevalence of diabetes in cases with CIED-related infection [15], [16], [17], [18].…”

Section: Discussionsupporting

confidence: 92%

“…In the current study, it has been noted that the total number of individuals and implants was increased in comparison to a previous study that was done by the same department which studied 2367 patients having 2630 implanted devices over 25 years from 1982 till 2007 [9]. A total of 59 infectious episodes were identified with an incidence of 2.99% of totally implanted devices and 2.6% of total procedures, and this denotes that the incidence of infection was declining in comparison to old studies done by the same department, which varied between 3.6% and 4.4%, respectively [9], [10], [11], [12].…”

Section: Discussioncontrasting

confidence: 49%

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Implantable Cardiac Device Infections Prevalence: Diagnostic and Therapeutic Implications

Yahia

Alazab

Aly

et al. 2021

Open Access Maced J Med Sci

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Background: It has been demonstrated that the use of cardiac implanted electronic devices (CIED) improve mortality and survivability in a variety of patient populations. Nevertheless, CIED related infection is a serious complication characterized by a high rate of mortality and morbidity. Objectives: To evaluate the prevalence of CIED related infections, risk factors, clinical and demographic characteristics, causative organisms, and the management and outcome of patients presented in the Critical Care Department, Cairo University. Methods: A retrospective analysis was conducted in 1871 individuals who had been implanted with a cardiac device with a total number of devices of 1968 and 2270 procedures performed from January 2007 to December 2017. Results: 59 infectious episodes were identified with an estimated incidence of 2.99% of inserted devices and 2.6% of total procedures. The infection rate was considerably higher in patients with multiple procedures than those who had a single procedure (9.27% vs. 1.18%; P<0.001). The individuals with a dual-chamber implantable cardiac defibrillator (ICD) and cardiac resynchronization therapy devices (CRTD) had the highest infection rate of 6.25% & 6.85%, respectively. The rate of pocket infection (PI) and CIED related endocarditis (CDE) was 1.54% & 1.06% of total devices respectively. Numerous risk factors have been found; the most significant of those are diabetes mellitus, recurrent procedures, the device's complexity, and the existence of more than one lead. Gram-positive cocci were the most isolated organisms in all positive cultures (69.23%). Echocardiography revealed lead vegetations and valvular vegetations in 22 patients and 2 patients respectively. In 53 cases (89.83%), the devices were removed; in 41 cases, the entire system was removed; and in 12 cases, only the generator was removed. The mortality rate was found to be 10.17%, having a considerably higher prevalence in CDE individuals than in pocket infection individuals (20.83% vs. 2.86%; P=0.025). Conclusion: In our center, while the rate of CIED implantation continues to increase, the incidence rate of CIED-related infection continues to decline. Until now, the infection burden associated with secondary intervention is still significantly high. The management strategy of selection is to eliminate the entire system for patients presented with infection especially those with CDE. However, the mortality rate is still high.

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