Infection after pacemaker implantation: infection rates and risk factors associated with infection in a population-based cohort study of 46299 consecutive patients

Johansen, Jens Brock; Jørgensen, Ole Dan; Møller, Mogens; Arnsbo, Per; Mortensen, Peter Thomas; Nielsen, Jens Cosedis

doi:10.1093/eurheartj/ehq497

Cited by 339 publications

(259 citation statements)

References 31 publications

(51 reference statements)

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“…More complex systems have a higher infection risk and potential benefits from these systems should be weighed against lower infection risk with more simple systems. 4,18,21 Meticulous pre-operative preparation is necessary. Fever within 24 hours before implant is associated with a 5-6 fold infection risk, and diagnosis and treatment of ongoing infection before implantation is therefore important.…”

Section: Before Implantationmentioning

confidence: 99%

“…40 Observational data and meta-analyses support this finding. 4,18,19,41,42 Supporting evidence for using topical antibiotics is lacking; 43 however, recently a promising development has been introduced. The TYRX TM Envelope is an antibacterial envelope releasing minocycline and rifampin in the generator pocket after CIED implantation.…”

Section: Peri-operativementioning

confidence: 99%

“…19,21,24 In a large, Danish cohort study, number of prior CIED procedures was strongly associated with a higher infection risk (see Figure 2). 18 Careful CIED prescription is important to avoid early need for system upgrade, and should include estimation of left ventricular function prior to implantation. Attention should be given to reduce anticipated generator replacements with selection of generators with best reported longevity, 51 and with careful programming to increase generator longevity.…”

Section: Re-operationmentioning

confidence: 99%

See 2 more Smart Citations

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: Before Implantationmentioning

confidence: 99%

Section: Peri-operativementioning

confidence: 99%

Section: Re-operationmentioning

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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“…Rates of device infections requiring explantation were 1.82/1000 after the first implantation and 5.32/1000 after replacement in a series of 46299 pacemakers implanted between 1982 and 2007 in Denmark. 19 The mortality rate associated with device infection was 8.2%, 4.6% and 5.8% for pacemaker, ICD and defibrillating biventricular pacemaker (CRT-D) respectively, in another cohort. 20 In a separate study, the mean time between implantation and explantation for device infection was 52 days.…”

Section: Disposal Of Cardiac Rhythm Control Devicesmentioning

confidence: 91%

Reuse of Cardiac Rhythm Control Devices: A Review

et al. 2013

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Cardiac rhythm control devices i.e. pacemakers, implantable cardioverter-defibrillators (ICDs) and biventricular pacemakers are at times lifesaving treatment and prevention of arrhythmia. But, despite definite indications, many people in the developing countries cannot afford these devices due to high cost, and succumb to premature death. On the other hand, after implantation, pacemakers and ICDs are sometimes underutilized because of premature explantation due to death of the recipient, device infection, or upgradation, leaving a considerable extent of serviceable battery life unused. Majority of these explanted devices are simply thrown away. Though made for single use, a growing body of evidence indicates the safety, efficacy and feasibility of reimplantation of the prematurely explanted devices in patient in need who is otherwise unable to afford a new one. Patients, physicians, morticians, and even the general public support the idea of device donation and recycling. A number of organizations around the world have engaged themselves in this benevolent effort, and t he feasibility of device reutilization programme has already been established. However, some logistic, legal and ethical concerns are yet to be solved. The statutory bodies and professional organizations should address the issue of device recycling to solve the unsolved issues and formulate standard practice guidelines. In that case, such medical wastes may turn into invaluable resources, and help ensuring equitable medical care throughout the world. Cardiovascular Journal Volume 6, No. 1, 2013, Page 52-59 DOI: http://dx.doi.org/10.3329/cardio.v6i1.16116

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“…1 Some investigators addressed the problem of CDIs in device-years, reporting an incidence of 1.8 to 1.9 per 1000 PM years and 3.1 to 10 per 1000 PM years for ICD and CRT-D, respectively [2][3][4][5] ; however, studies comparing the incidence of CDIs in patients with ICEDs have provided conflicting results.…”

Section: Introductionmentioning

confidence: 99%

Cardiac device infections: definition, classification, differential diagnosis, and management

Polewczyk¹,

Janion²,

Kutarski³

2016

Polish Archives of Internal Medicine

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275an ICD, and especially with a CRT-D, no such disproportions have been reported in other studies. The Dutch device registry including over 3000 patients with 1200 PMs, 1414 ICDs, and 795 CRT-Ds implanted between 2000 and 2007, did not show any differences in the development of CDIs between different pacing systems.6 Between 2006 and 2015, we conducted a single-center registry study including 1801 patients undergoing transvenous lead extraction (TLE) (1266 PMs, 385 ICDs, and 150 CRT-Ds). The registry showed a lower incidence of infectious complications in patients with ICDs than in those with PMs (35.8% vs 42.2%; P = 0.009), whereas the highest rate of infections was found in patients with CRT-Ds, namely, 51.3% of patients with CDI-associated TLE (unpublished data).Classification of cardiac device infections CDIs still pose a serious clinical problem. Varying terminology and different CDI classifications are one of the major diagnostic and therapeutic challenges that are encountered in routine clinical practice. The problem arises during an attempt to estimate Introduction The era of cardiac pacing began in the 1960s. Since then, the use of pacemakers (PMs) has increased rapidly and now includes traditional PMs, implantable cardioverter--defibrillators (ICDs), and cardiac resynchronization therapy devices (CRT-Ds). Unfortunately, the progress in pacing therapy is associated with the development of infections, which constitute an increasing clinical challenge and reduce positive effects of treatment. At present, the incidence of cardiac device infections (CDIs) in patients with implantable cardiac electronic devices (ICEDs) is estimated to range from 0.5% to 2.2%; however, the exact incidence is difficult to assess because different studies use different methodologies.1 Some investigators addressed the problem of CDIs in device-years, reporting an incidence of 1.8 to 1.9 per 1000 PM years and 3.1 to 10 per 1000 PM years for ICD and CRT-D, respectively 2-5 ; however, studies comparing the incidence of CDIs in patients with ICEDs have provided conflicting results.Apart from the above data showing a significantly higher incidence of CDIs in patients with ABSTRACTCardiac device infections (CDIs) continue to be a serious clinical problem, with varying terminology and different classifications constituting one of the major diagnostic and therapeutic challenges in routine clinical practice. The problem invariably arises during an attempt to estimate the extent of the infection, which in consequence determines the choice of treatment strategy (duration of antibiotic therapy). The most serious form of CDI is lead-related infective endocarditis (LRIE). There are no clearly established diagnostic criteria for this disease; the available Duke University criteria are difficult to apply in patients with a suspicion of LRIE because of low sensitivity. As the treatment of LRIE is expensive and troublesome, there is a tendency to underdiagnose this condition and seek any intermediary forms between local pocket infection and def...

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Infection after pacemaker implantation: infection rates and risk factors associated with infection in a population-based cohort study of 46299 consecutive patients

Cited by 339 publications

References 31 publications

Management of Cardiac Electronic Device Infections: Challenges and Outcomes

Management of Cardiac Electronic Device Infections: Challenges and Outcomes

Reuse of Cardiac Rhythm Control Devices: A Review

Cardiac device infections: definition, classification, differential diagnosis, and management

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