A Roadmap for Reducing Cardiac Device Infections: a Review of Epidemiology, Pathogenesis, and Actionable Risk Factors to Guide the Development of an Infection Prevention Program for the Electrophysiology Laboratory

Abstract

Basic prevention practices, such as administration of systemic antimicrobials prior to incision and delaying the procedure in the setting of fever or elevated INR, are helpful for day-to-day prevention of cardiac device infections. Small single-center studies provide proof-of-concept that bundled prevention interventions can reduce infections, particularly in outbreak settings. However, data regarding which prevention strategies are the most important is limited as are data regarding the optimal prevention program for day-to-day prevention (Borer et al. Infect Control Hosp Epidemiol 25(6):492-7 2004; Ahsan et al. Europace 16(10):1482-9 2014). Evolution of infection prevention programs to include ambulatory and procedural areas is crucial as healthcare delivery is increasingly provided outside of hospitals and operating rooms. The focus on traditional operating rooms and inpatient care leaves the vast majority of healthcare delivery-including cardiac device implantations in the electrophysiology laboratory-uncovered.

Cardiac implantable electronic device infection in the cardiac referral center in Thailand: incidence, microbiology, risk factors, and outcomes

“…An increased rate of CIED infection in the United Kingdom was also reported. 4 Previous studies showed risk factors associated with CIED infection included early CIED re-intervention, 5,6 postoperative hematoma, 7-9 CIED replacement, [9][10][11] more complex CIED, 6,12,13 use of temporary pacemaker prior to implantation, 5,9 a large number of prior procedures, 5 prior CIED infection, 14,15 lack of proper preoperative antibiotics, 14 longer procedure time, 6,14 fever or systemic infection, 5,14 chronic kidney disease, 6,14,16,17 hemodialysis, 6 chronic skin disease, 14 corticosteroid treatment, 9 chronic obstructive pulmonary disease, 9,14,15 diabetes, 9,14 malignancy, 14 male gender, 10,16 and younger age. 10,12 In western countries, gram-positive cocci are major types of CIED infection (from 67.5% of patients to 92.5% of isolates across ten studies).…”

“…Previous studies showed risk factors associated with CIED infection included early CIED re‐intervention, postoperative hematoma, CIED replacement, more complex CIED, use of temporary pacemaker prior to implantation, a large number of prior procedures, prior CIED infection, lack of proper preoperative antibiotics, longer procedure time, fever or systemic infection, chronic kidney disease, hemodialysis, chronic skin disease, corticosteroid treatment, chronic obstructive pulmonary disease, diabetes, malignancy, male gender, and younger age …”

Prevention of Cardiac Implantable Electronic Device Infections: A Review

“…Apart from classic pacemakers (PM) and implantable cardioverter-defibrillators (ICDs), more complex systems, such as cardiac resynchronisation therapy devices (CRT), are also being implanted more. Over a million CIEDs are implanted each year [ 1 ]. The increasing number of CIEDs used and their complexity are unfortunately associated with a growing number of complications, among which CIED infections are particularly unfavourable in terms of prognosis [ 2 ].…”