Cardiac implantable electronic device infections: Presentation, management, and patient outcomes

Tarakji, Khaldoun G.; Chan, Eric J.; Cantillon, Daniel J.; Doonan, Aaron L.; Hu, T. C.; Schmitt, Steven; Fraser, Thomas G.; Kim, Alice; Gordon, Steven M.; Wilkoff, Bruce L.

doi:10.1016/j.hrthm.2010.05.016

Cited by 251 publications

(281 citation statements)

References 20 publications

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“…Observational studies found that 20-40 % of patients were discharged without CIED re-implantation. 32,66,67 Some patients have developed indication for more complex CIED treatment while others will need no re-implantation at all (e.g. malignancy in patients with prophylactic ICD).…”

Section: Re-implantationmentioning

confidence: 99%

“…31 System extraction is associated with a small risk of major complications, particularly vascular lacerations causing haemothorax and death. 32,70,[79][80][81][82] Extraction-related mortality rates are 0.1-0.8 % in large experienced centres. 70,83 In one large, single-centre study, including more than 5,000 lead extractions, 43 % of which were due to infection, risk of major complications was 1.8 %, and minor complications 3.6 %.…”

Section: Outcomes Of Cardiac Implantable Electronic Device Infectionmentioning

confidence: 99%

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Management of Cardiac Electronic Device Infections: Challenges and Outcomes

Kirkfeldt¹,

Johansen²,

Nielsen³

2016

Arrhythmia &Amp; Electrophysiology Review

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Cardiac implantable electronic device (CIED) infection is an increasing problem. Reasons for this are uncertain, but likely relate to an increasing proportion of implantable cardioverter defibrillator (ICD) and cardiac resynchronisation therapy (CRT) devices implanted, as well as implantations in ‘higher risk’ candidates, i.e. patients with heart failure, diabetes and renal failure. Challenges within the field of CIED infections are multiple with prevention being the most important challenge. Careful prescription of CIED treatment and careful patient preparation before implantation is important. Diagnosis is often difficult and delayed by subtle signs of infection. Treatment of CIED infection includes complete system removal in centres experienced in CIED extraction and prolonged antibiotic therapy. Meticulous planning and preparation before system extraction and later CIED re-implantation is essential for better patient outcome. Future strategies for reducing CIED infection should be tested in sufficiently powered, multicentre, randomised controlled trials

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Section: Re-implantationmentioning

confidence: 99%

Section: Outcomes Of Cardiac Implantable Electronic Device Infectionmentioning

confidence: 99%

Management of Cardiac Electronic Device Infections: Challenges and Outcomes

Kirkfeldt¹,

Johansen²,

Nielsen³

2016

Arrhythmia &Amp; Electrophysiology Review

View full text Add to dashboard Cite

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“…3). [14][15][16] The most common organism found across multiple studies is the Staphylococcus species. Methicillin-resistant Staphylococcus aureus, methicillin-sensitive S. aureus, methicillin-resistant S. epidermidis, and methicillin-sensitive S. epidermidis contribute to more …”

Section: Microbiology Of Device Infection Pacemakersmentioning

confidence: 99%

“…3). [14][15][16] Staphylococci and certain Candida infections are difficult to treat due to their ability to build biofilms on surfaces of foreign bodies such as CIEDs. Biofilms are a thick, multilayered film that mechanically traps bacteria, which when dormant, are highly resistant to bacteriocidal antibiotics via inhibition of cell wall biosynthesis, such as β-lactam antibiotics.…”

Section: Microbiology Of Device Infection Pacemakersmentioning

confidence: 99%

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Treatment of Infected Cardiac Implantable Electronic Devices

Fakhro

Jalalabadi

Brown

et al. 2016

Seminars in Plastic Surgery

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Since their earliest application, cardiac implantable electronic devices (CIEDs), such as pacemakers, implantable defibrillators, and left ventricular assist devices (LVADs), have proven beneficial in the prevention of fatal cardiac-related disorders. 1 The past 50 years have seen a sharp rise in cardiac implantable device use with a resultant decline in deaths from ischemic, myocardial, and cardiac rhythm causes. 2 As the indications and guidelines governing CIED use broaden, so too does their widespread employment. 3 The rate of CIED infections has mirrored their increased use with some studies suggesting that the rate of device infections has overshadowed their implantation rate. 4 Infections pose a severe burden on patients, lead to significant health care costs and lengthy hospital stays, and may also lead to mortality. 5 When compared with noninfectious cardiac device complications, pacemaker infections result in an 8.4-to 11.6-fold increase in mortality rates along with a mean hospitalization cost ranging from $31,149 to $55,003. 6 Although both pacemakers and LVADs are implantable cardiac devices, their infection profile and treatment differ significantly due to the size of the device and the need for an external power source for the LVAD. However, both demonstrate a wide range of infection rates, with the true incidence of infection remaining elusive. 7 Topkara et al report a pacemaker infection rate of between 13% and 80%; however, others estimate it to be between 2% and 4% with rates rising 124% between years 1990 to 1999 and a 57% rise from 2004 to 2006, respectively. 8,9 Similarly, infection rates related to LVAD placement demonstrate a large range of between 13% and 80% among recipients. 10 This wide variability in infection risk is in part due to different types of infections that have been included under the category of CIED-related infections. Various reports broadly included patients with surgical site infections, postoperative pneumonia, central venous catheter-related sepsis, and nosocomial urinary tract infections, in addition to infection of the CIED. 10 Various comorbidities may contribute to CIED infections. Patients of advanced age, with congestive heart failure, with a metastatic malignancy, on corticosteroid therapy, or with renal failure are more likely to develop CIED infections thereby increasing their mortality. 9 Device Infection Diagnosis PacemakersThe diagnosis of pacemaker infections is often challenging. Pocket site infections are diagnosed clinically, often presenting with inflammatory skin changes including pain, swelling, AbstractWith their rising benefits, cardiac implantable electronic devices (CIEDs) such as pacemakers and left ventricular assist devices (LVADs) have witnessed a sharp rise in use over the past 50 years. As indications for use broaden, so too does their widespread employment with its attendant rise of CIED infections. Such large numbers of infections have inspired various algorithms mandating treatment. Early diagnosis of inciting organisms is crucial to...

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