Mortality and Cost Associated With Cardiovascular Implantable Electronic Device Infections

Sohail, M. Rizwan; Henrikson, Charles A.; Braid-Forbes, Mary Jo; Forbes, Kevin F.; Lerner, Daniel J.

doi:10.1001/archinternmed.2011.441

Cited by 310 publications

(237 citation statements)

References 24 publications

(37 reference statements)

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“…Other implantable therapeutic foreign bodies in patients with normal immune function, such as pacemakers or implantable cardioverter defibrillators, are more prone to infections (1-6%), which increases the risk of mortality even after successful treatment of the infection [11,12,13]. Pacemaker infection rates from the 1970s to 1980s were even higher (1-19.9%) [14].…”

Section: Resultsmentioning

confidence: 99%

Percutaneous Atrial Septal Closure in Immunocompromised Patients

Kar¹,

Aboulhosn²,

Tandar³

et al. 2017

jshd

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Background: Percutaneous closure devices for cardiac defects have been used with a high degree of efficacy and safety. However, patients with autoimmune disease or immunosuppression are excluded in clinical trials due to their presumed higher risk. Percutaneous closure of patent foramen ovale (PFO) or atrial septal defect (ASD) is safe in patients who are immunosuppressed or have autoimmune disease. Methods: A retrospective observational multicenter study was performed including 24 patients who were immunocompromised or had autoimmune disease from vasculitis, Human Immunodeficiency Virus, hepatitis, cancer, or renal transplant and underwent percutaneous PFO or ASD closure for cryptogenic stroke (9.38%), desaturation (5.21%), migraine (7.29%), or a combination of these diagnoses (3.13%). Post-procedure follow-up included clinical evaluation at 3-6 months or telephone questionnaire up to 8 years later. Results: Of the 24 patients who met inclusion criteria (53 ± 14 years of age, follow-up of 21 ± 28 months), 19 had a PFO (79%), 5 had an ASD (21%), and 21 (88%) underwent closure. There was no evidence of endocarditis, device erosion, exacerbation of migraine, or recurrent stroke. Only one patient (4%) experienced a transient neurologic deficit after closure due to complex migraine with visual aura. Mortality status, which was verified by the social security death index, showed five deaths related to non-cardiac conditions. Conclusion: This observational study of an uncommon condition suggests that percutaneous closure of a PFO or ASD is safe in immunocompromised patients.

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Section: Resultsmentioning

confidence: 99%

Percutaneous Atrial Septal Closure in Immunocompromised Patients

Kar¹,

Aboulhosn²,

Tandar³

et al. 2017

jshd

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“…The overall incidence of infections ranged from 0.5-2.2% of patients in a review [10]. Several risk factors for ICD infection have been reports among them, male sex, lack of antimicrobial prophylaxis during the implantation procedure, the number of prior cardiac implantation procedures, and type of device [11]. ICD pocket infection has been associated with increased hospital length-of-stay and mortality.…”

Section: Discussionmentioning

confidence: 99%

Implantable cardioverter defibrillator pocket infection caused by Stenotrophomonas maltophilia

Buege¹,

Bushman²,

Best³

et al. 2016

IJCRI

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International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. We report a case of implantable cardioverter-defibrillator (ICD) pocket infection caused by S. maltophilia in an 85-year-old male. The patient recovered after ICD removal and antimicrobial therapy with ceftazidime. Conclusion:As ICD implantation becomes more common, infection of the pocket space these devices are placed in will probably increase in number. Although rare, clinicians should consider rare pathogens such as S. maltophilia in their differential diagnosis.

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“…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. 21 So, logically, some of these explanted devices should have adequate residual battery life for reuse, and after resterilization, may be a potential source of recycled devices.…”

Section: Disposal Of Cardiac Rhythm Control Devicesmentioning

confidence: 95%

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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Mortality and Cost Associated With Cardiovascular Implantable Electronic Device Infections

Abstract: Infection associated with CIED procedures resulted in substantial incremental admission mortality and long-term mortality that varied with the CIED type and occurred, in part, after discharge. Almost half of the incremental admission cost was for intensive care.

Cited by 310 publications

References 24 publications

Percutaneous Atrial Septal Closure in Immunocompromised Patients

Percutaneous Atrial Septal Closure in Immunocompromised Patients

Implantable cardioverter defibrillator pocket infection caused by Stenotrophomonas maltophilia

Reuse of Cardiac Rhythm Control Devices: A Review

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