Long-term outcomes following infection of cardiac implantable electronic devices: a prospective matched cohort study

Deharo, Jean‐Claude; Quatre, Amandine; Mancini, Julien; Khairy, Paul; Dolley, Yvan Le; Casalta, Jean‐Paul; Peyrouse, Eric; Prévôt, Sébastien; Thuny, Franck; Collart, Frédéric; Raoult, Didier; Habib, Gilbert; Franceschi, Frédéric

doi:10.1136/heartjnl-2012-301627

Cited by 129 publications

(138 citation statements)

References 32 publications

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“…74 All-cause mortality following CIED infection is considerable, ranging from 6 % to 35 % at 2 years or longer follow-up, although many deaths are not infection-related. 10,66,70,[74][75][76] In most of these studies, more than 90 % of patients underwent complete CIED removal. Mortality with endocarditis is reported between 24.5 % and 29.0 %, 31,71,77 and CIED infections with endocarditis have a higher mortality than pocket infection.…”

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: Outcomes Of Cardiac Implantable Electronic Device Infectionmentioning

confidence: 99%

“…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%

Management of Cardiac Electronic Device Infections: Challenges and Outcomes

Kirkfeldt¹,

Johansen²,

Nielsen³

2016

Arrhythmia &Amp; Electrophysiology Review

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“…4,5,17,[49][50][51][52] Several predictors of long-term mortality have been identified including older age, heart failure, infective endocarditis, renal failure and long-term corticosteroid therapy. 46,53 However, these high mortality rates must be seen in the context of populations with multiple co-morbidities. Indeed, device patients have shown high mortality rates.…”

Section: Discussionmentioning

confidence: 99%

“…Epicardial pacing is an option but has been associated with higher mortality rates. 46 An interesting alternative is temporary pacing using a screw-in pacing lead connected to a re-use can strapped on the skin of the patients, 47,48 the so called 'semi-permanent' pacing (see Figure 5). This approach allows patients to safely await implantation of a new device for the recommended 72 hours to 14 days depending on clinical status.…”

Section: Reimplantation Of a Device After Infectionmentioning

confidence: 99%

Management of Cardiac Implantable Electronic Device Infection

Podoleanu

Deharo

2014

Arrhythm Electrophysiol Rev

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The increasing use of cardiac implantable electronic devices (CIEDs) for management of cardiac conditions has over the last few years been associated with higher infection rates.1 Expanded CIED use alone cannot account for this rise, 2-4 which involves both patient-and device-related factors. Indeed patients are tending to be older and presenting with co-morbidities, while devices are becoming more sophisticated and requiring more leads and revision. 6 In terms of patient demographics, the occurrence of CIED infection was greatest in white males over 65 years of age, and the most significant associated co-morbidities were renal failure, respiratory failure, heart failure and diabetes. The greatest risk factors for mortality were respiratory failure (odds ratio [OR] 13.58; 95 % confidence interval [CI] 12.88-14.3), renal failure (OR 4.28; 95 % CI 4.04-4.53) and heart failure (OR 2.71; 95 % CI 2.54-2.88). Post-operative haematoma was more frequent in patients who developed infection. Sites reporting higher infection rates had sicker patients and lower overall procedure volumes. AbstractDespite improved preventive measures, infection associated with the use of cardiac implantable electronic devices (CIEDs) to treat often life-threatening conditions is rising at an average annual rate of almost 5 %. This rise is being driven by the increasing complexity of CIED technology and by the advancing age and co-morbidities of the patients. Although CIED infection is usually suspected based on local signs at the generator pocket site, diagnosis can be challenging in patients presenting no local manifestations or symptoms. Diagnostic methods include microbiological testing and echocardiography, and may be completed by positron emission tomography (PET)/computed tomography (CT) scan in selected cases. CIED infection requires a multidisciplinary approach in view of hardware extraction, targeted antibiotic therapy and reimplantation on an as-needed basis. Antibiotic prophylaxis targeting staphylococcal flora is recommended but the relation of these infections to medical care exposes patients to multi-resistant bacteria. New preventive measures utilising an antibacterial sleeve look promising. Treatment can be started on an empirical basis using an antistaphylococcal agent but must be continued using targeted antibiotic therapy. Crucial questions remain as to the best prevention strategy, optimal duration and timing of antibiotic therapy, and the most effective reimplantation technique.

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“…15,[20][21][22][23][24][25] If patients are pacemaker dependent, a temporary pacer is placed at or before the time of exchange. 15,23 Reimplantation of devices, if necessary, depends on the location of the infection. Preferably, the pacemaker should be placed on Treatment of Infected Cardiac Implantable Electronic Devices Fakhro et al 63…”

Section: Pacemakersmentioning

confidence: 99%

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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Long-term outcomes following infection of cardiac implantable electronic devices: a prospective matched cohort study

Abstract: In patients with CIED infection managed by recommended therapy, long-term mortality rates are similar to comparable controls. Independent predictors include patient and disease-related factors, in addition to implantation of right ventricular epicardial pacemakers.

Cited by 129 publications

References 32 publications

Management of Cardiac Electronic Device Infections: Challenges and Outcomes

Management of Cardiac Electronic Device Infections: Challenges and Outcomes

Management of Cardiac Implantable Electronic Device Infection

Treatment of Infected Cardiac Implantable Electronic Devices

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