Risk Factors for Mortality in Patients With Cardiac Device-Related Infection

Baman, Timir S.; Gupta, Sanjaya; Valle, Javier A.; Yamada, Elina

doi:10.1161/circep.108.816868

Cited by 122 publications

(112 citation statements)

References 32 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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“…34,35 A 2009 study, for example, found an 18% all-cause mortality from CIED infections at 6 months. 38 Given the high risks associated with these infections, the AHA recommends the use of prophylactic antibiotics in all patients, regardless of prosthetic joint status, before CIED placement. Specifically, they recommend that cefazolin be administered intravenously within 1 hour before the incision or vancomycin within 2 hours of the incision.…”

Section: Dental Proceduresmentioning

confidence: 99%

Antibiotic Prophylaxis for Patients with a History of Total Joint Replacement

DeFroda

Lamin

Gil

et al. 2016

The Journal of the American Board of Family Medicine

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As the population ages and people remain active into the 7th and 8th decades of life, the frequency of total joint replacement is increasing. Following joint replacement surgery, patients inevitably require various invasive procedures as part of their routine health maintenance, including, but not limited to, dental care, colonoscopy, cystoscopy, and cardiac catheterization. There is scant evidence to support the use of periprocedural prophylactic antibiotics in the prevention of late total joint infection. The guidelines for the usage of periprocedural antibiotics have changed as knowledge of the pathophysiology of joint infection has evolved. We review the current recommendations from subspecialty academic organizations regarding antibiotic prophylaxis for patients undergoing routine urologic, gastrointestinal, dental, and cardiac procedures after total joint replacement. (J Am Board Fam Med 2016;29:500 -507.)

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“…53,54 In 1 study, the standardized adjusted incremental and total admission costs for infection were $14 360 to $16 498 and $28 676 to $53 349 for pacemakers and implantable cardioverter-defibrillators respectively. 55 Initial conservative management of confirmed CEID infection is associated with higher relapses and mortality.…”

Section: Outcomes With Cied Infectionsmentioning

confidence: 99%