Allograft infections post lung transplantation have a significant impact on morbidity and mortality. We report a rare case of triple viral infection with adenovirus, Herpes Simplex virus (HSV) and Cytomegalovirus (CMV) in a lung transplant recipient.
The last few decades saw a significant increase in the use of cardiac implantable electronic devices (CIED) such as pacemakers (PPM), automated implantable cardioverter defibrillator (AICD), and cardiac resynchronization devices. A US study reported an increase of 12% in the number of CIED implantations between 2004 and 2006. 1 The rate of cardiac device infection (CDI) is estimated to be 0.5% with primary implants, and ranges from 1% to 7% with secondary procedures. [2][3][4] Underlying factors associated with CDI include combination devices, longer procedure time, 5,6 implantation by inexperienced operators, 3,7,8 and advanced age. 9Comorbid conditions associated with CDI include diabetes mellitus (DM), 10 renal insufficiency 10,11 and immunosuppression at the Abstract Background: Cardiac implantable electronic devices (CIED) have become a common treatment modality in clinical practice. The increase in utilization of these devices has been associated with an increase in infection rates. Published guidelines define when a device is deemed infected (CDI); recommendations for the work-up of CDI and criteria for extraction. Few data exist as to adherence to these guidelines. Objective:We wanted to o evaluate whether devices diagnosed as CDI fit guidelines, whether clinicians followed work-up recommendation of CDI, and whether CIED was extracted according to the guidelines criteria in our hospital. Methods:A retrospective review was performed in our hospital between 2008 and 2017. Adult patients (pts) 18 years and older who had their device extracted (DE)with a diagnosis of CDI were included. A total of 95 pts were identified. Results:We included 95 pts who were diagnosed as having CDI and who had their DE. Work-up of patients with a diagnosis of CDI was inconsistently followed. Blood cultures, Echocardiogram, lead cultures (LC), and device pocket cultures (PC) were done in 100%, 90.5%, 75.6%, and 49.3%, respectively. Thirty out of 90 pts. (33%) did not meet guidelines criteria for extraction. Conclusions:In our institution, a one third of the pts diagnosed with CDI who had DE had no indication for DE per guidelines recommendations. Clinicians did not follow recommendations for work-up of CDI consistently. Low adherence was seen in obtaining LC and PC. CIED extraction guidelines should be followed to prevent unnecessary complications and cost.
BackgroundCardiovascular implantable electronic device (CIED) such as pacemaker (PPM) and automated implantable cardiac defibrillator (AICD) are commonly utilized in clinical practice. Definitions of device infection (DI) and guidelines for the work up and device extraction (DE) have been published by the American Heart Association and the Infectious Disease Society of America. Our objective was to evaluate whether the work up of DI as recommended was followed, and whether the device was extracted according to guidelines.MethodsA retrospective review in a 680-bed tertiary care hospital. Adult patients (patients) >18 years. who were diagnosed as having a DI and had the device extracted between 2008 and 2017 were included. Data were collected on demographics, device duration, blood culture (BC), echocardiogram utilization, lead cultures (LC) and device pocket cultures, appropriateness of extraction as per guidelines.ResultsNinety-five patients were included. Mean age 68 years (range 23–90). 67 (70%) were male. Devices included: AICD in 75 (79%), PPM in 20(21%). CIED was present <1 year prior to infection in 24(24%). Compliance with guidelines recommendation to draw blood cultures, obtain an echocardiogram and send lead cultures and device pocket cultures were seen in 100%, 90.5% and 49.4% and 67.7%, respectively. Criteria for extraction was met in 65/95 (69%); reason for extraction was a pocket infection in 16/65(24.6%), bacteremia in 49/65 (75%), infective endocarditis in 38/65(58%). Thirty (31.5%) had device extracted without meeting guidelines recommendation, in 17 a diagnosis of pocket infection but without microbiological criteria or clinical diagnosis. In 9 patients lead vegetations were seen but no cultures to support extraction. Mortality was seen in 4 patients, one during the extraction procedure.ConclusionIn our institution, 1/3 of the patients diagnosed with DI had no indication for DE. Guidelines recommendation for CIED extraction should be followed as extraction could be associated with significant complications. In this study, overall compliance with guidelines work up recommendations were not consistently followed, especially LC and device pocket cultures.Disclosures All authors: No reported disclosures.
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