Cardiac implantable electronic device infection: Does the device need to be extracted?

Abstract

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.

A Case of Revelation Due to Pegfilgrastim

“…Infectious disease physicians were then recommended to continue monitoring blood cultures with empiric antibiotics. Our cardiologist and interventional radiologist also discussed medical management vs. replacement of the patient's infected valves, pacemaker, and implantable cardioverter defibrillator (ICDs) (Figure 4a , 4b ) [ 14 , 15 ]. Unfortunately, in many cases, using antibiotic treatment to manage infected hardware hasn’t been done but rather just as a prophylactic measure [ 16 - 18 ].…”