Treatment of Infected Cardiac Implantable Electronic Devices

Abstract

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...

Rare case of implantable cardioverter defibrillator infection caused byStenotrophomonas maltophiliaandPantoea calida

“…If deemed necessary, 7–15 days is generally an acceptable time to reimplantation in case the infection was limited to the pocket site. However, patients who develop infective endocarditis usually require longer time lapse before considering reimplantation 2…”

“…Infections from cardiac implantable electronic defibrillator (CIED) can range from a localised device pocket infection to the more challenging lead infections and endocarditis. Patients with various chronic medical conditions such as chronic renal failure and diabetes mellitus are at higher risk for these infections 1 2. Increased use of these devices over the recent years has led to higher rates of CIED-related infections, mortality and hospitalisation.…”

Left Ventricular Assist Device Infections

“…Pocket infections must typically be managed with surgical debridement in the operating room with techniques such as omental wrapping of the pump housing to cover exposed metal and to close surgical defects [89,90]. In rare instances, extrapolating from the orthopedic surgery literature, antibiotic impregnated beads have been placed in the pocket (reviewed in [91,92]) although this has not been studied in a rigorous manner. Arguably, tissue levels of parenteral antibiotics are sufficient to treat residual infection once source control has been achieved.…”

Intracardiac Abscess and Pacemaker Lead Infection Secondary to Hematogenous Dissemination of Methicillin-Sensitive Staphylococcus Aureus from a Prior Diabetic Foot Ulcer and Osteomyelitis

“…However, reports of pacemaker infection rates vary: some suggest 2% to 4% annually, while others suggest 13% to 80%. Between 2004 and 2006, the rate of pacemaker infections increased 57% [ 2 ]. Cardiac implantable device infection incidence has been reported to be 0.7% to 2.2% [ 3 ].…”