Permanent Pacemaker and Implantable Cardioverter Defibrillator Infection

Uslan, Daniel Z.; Sohail, M. Rizwan; Sauver, Jennifer L. St.; Friedman, Paul A.; Hayes, David L.; Stoner, Sarah M.; Wilson, Walter R.; Steckelberg, James M.; Baddour, Larry M.

doi:10.1001/archinte.167.7.669

Cited by 360 publications

(251 citation statements)

References 33 publications

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“…Despite adequate treatment, reported death rates range from 8.0 % to 26.9 %. 4,5,17,[49][50][51][52] Several predictors of long-term mortality have been identified including older age, heart failure, infective endocarditis, renal failure and long-term corticosteroid therapy. 46,53 However, these high mortality rates must be seen in the context of populations with multiple co-morbidities.…”

Section: Discussionmentioning

confidence: 99%

Management of Cardiac Implantable Electronic Device Infection

Podoleanu

Deharo

2014

Arrhythm Electrophysiol Rev

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The increasing use of cardiac implantable electronic devices (CIEDs) for management of cardiac conditions has over the last few years been associated with higher infection rates.1 Expanded CIED use alone cannot account for this rise, 2-4 which involves both patient-and device-related factors. Indeed patients are tending to be older and presenting with co-morbidities, while devices are becoming more sophisticated and requiring more leads and revision. 6 In terms of patient demographics, the occurrence of CIED infection was greatest in white males over 65 years of age, and the most significant associated co-morbidities were renal failure, respiratory failure, heart failure and diabetes. The greatest risk factors for mortality were respiratory failure (odds ratio [OR] 13.58; 95 % confidence interval [CI] 12.88-14.3), renal failure (OR 4.28; 95 % CI 4.04-4.53) and heart failure (OR 2.71; 95 % CI 2.54-2.88). Post-operative haematoma was more frequent in patients who developed infection. Sites reporting higher infection rates had sicker patients and lower overall procedure volumes. AbstractDespite improved preventive measures, infection associated with the use of cardiac implantable electronic devices (CIEDs) to treat often life-threatening conditions is rising at an average annual rate of almost 5 %. This rise is being driven by the increasing complexity of CIED technology and by the advancing age and co-morbidities of the patients. Although CIED infection is usually suspected based on local signs at the generator pocket site, diagnosis can be challenging in patients presenting no local manifestations or symptoms. Diagnostic methods include microbiological testing and echocardiography, and may be completed by positron emission tomography (PET)/computed tomography (CT) scan in selected cases. CIED infection requires a multidisciplinary approach in view of hardware extraction, targeted antibiotic therapy and reimplantation on an as-needed basis. Antibiotic prophylaxis targeting staphylococcal flora is recommended but the relation of these infections to medical care exposes patients to multi-resistant bacteria. New preventive measures utilising an antibacterial sleeve look promising. Treatment can be started on an empirical basis using an antistaphylococcal agent but must be continued using targeted antibiotic therapy. Crucial questions remain as to the best prevention strategy, optimal duration and timing of antibiotic therapy, and the most effective reimplantation technique.

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Section: Discussionmentioning

confidence: 99%

Management of Cardiac Implantable Electronic Device Infection

Podoleanu

Deharo

2014

Arrhythm Electrophysiol Rev

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“…(3,4,7) Staphylococci are the most frequent pathogens. (7,9) It is important to note that Duke criteria are difficult to apply in these patients because of lower sensitivity. (10) Because septic pulmonary embolism is a very frequent complication of PMIE, modifications of Duke criteria have been proposed.…”

Section: Discussionmentioning

confidence: 99%

“…(10,13) Hematogenous colonization of the PM conducting system during the course of a bacteremia from a distant focus has rarely been demonstrated since the pacing system is rapidly covered by neoendothelium and fibrous tissue, which prevents the foreign surface from being coated by microorganisms. (7,9,10) However, in bacteraemic patients with fever and positive blood culture results, hematogeneous seeding of the device was presumed to be the mode of colonization of the system. (7,9,10) The potential sources include infections at other sites, including the urinary, hepatobiliary, gastrointestinal, and respiratory tracts.…”

Section: Discussionmentioning

confidence: 99%

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Atypical presentation of thrombosis of a permanent pacemaker lead

2012

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“…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][3][4][5] ; however, studies comparing the incidence of CDIs in patients with ICEDs have provided conflicting results.…”

Section: Introductionmentioning

confidence: 99%

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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Permanent Pacemaker and Implantable Cardioverter Defibrillator Infection

Cited by 360 publications

References 33 publications

Management of Cardiac Implantable Electronic Device Infection

Management of Cardiac Implantable Electronic Device Infection

Atypical presentation of thrombosis of a permanent pacemaker lead

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

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