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Bielick CG, Arnold CJ, Chu VH. Cardiovascular Implantable Electronic Device Infections: A Contemporary Review. Infect Dis Clin North Am 2024:S0891-5520(24)00055-2. [PMID: 39261140 DOI: 10.1016/j.idc.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Abstract
Infections associated with cardiac implantable electronic devices (CIEDs) are increasing and are a cause of significant morbidity and mortality. This article summarizes the latest updates with respect to the epidemiology, microbiology, and risk factors for CIED-related infections. It also covers important considerations regarding the diagnosis, management, and prevention of these infections. Newer technologies such as leadless pacemakers and subcutaneous implantable cardioverters and defibrillators are discussed.
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Affiliation(s)
- Catherine G Bielick
- Division of Infectious Diseases, University of Virginia, Charlottesville, VA, USA; Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Hospital Medicine, West Span 201, Boston, MA 02215, USA.
| | - Christopher J Arnold
- Division of Infectious Diseases, University of Virginia, Charlottesville, VA, USA
| | - Vivian H Chu
- Division of Infectious Diseases, Duke University Health System, Box 102359, Durham, NC 27710, USA
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Ponta G, Ranzenigo M, Marzi A, Oltolini C, Tassan Din C, Uberti-Foppa C, Spagnuolo V, Mazzone P, Della Bella P, Scarpellini P, Castagna A, Ripa M. Combination of High-Dose Daptomycin and Ceftriaxone for Cardiac Implantable Electronic Device Infections: A 10-Year Experience. Clin Ther 2024:S0149-2918(24)00211-X. [PMID: 39183124 DOI: 10.1016/j.clinthera.2024.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 07/20/2024] [Accepted: 07/26/2024] [Indexed: 08/27/2024]
Abstract
PURPOSE Cardiac implantable electronic device (CIED) infections are increasingly common. Gram-positive bacteria such as coagulase negative staphylococci and Staphylococcus aureus are the most commonly involved pathogens. The aim of this study was to describe the characteristics and outcome of patients with CIED infections who underwent device removal and were empirically treated with high dose (8-12 mg/kg daily) daptomycin (DAP) in combination with ceftriaxone (CRO). METHODS Retrospective, single center study including patients admitted at IRCCS San Raffaele Hospital (Milan, Italy), from June 2011 to June 2021, who underwent device removal for CIED infection and were empirically treated with DAP/CRO. FINDINGS Overall, 147 patients were included in this study. Median duration of therapy was 16 days (IQR 14-26). Empirical treatment with DAP/CRO was confirmed as definitive treatment in 140 patients (95.2%). In 7 (4.8%) patients DAP/CRO were discontinued according to the definite microbiological isolates: Corynebacterium spp. (4), Pseudomonas aeruginosa (2), Enterobacter cloacae (1). Ten patients (6.8%) underwent treatment simplification to narrow-spectrum antibiotics. One patient (0.6%) interrupted DAP-CRO due to pancytopenia. 6-month follow-up was available for 123/147 patients (83.7%): 9 patients recurred with a CIED infection (7.3%), and 9 died (7.3%). IMPLICATIONS In our 10-year experience, high-dose DAP in combination with CRO represented a good option for empirical therapy of CIED infections. DAP-CRO combination was safe and effective, showing no significant drug-related adverse events and low rates of 6-month recurrence and mortality.
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Affiliation(s)
- Giacomo Ponta
- San Raffaele Vita-Salute University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Department of Infectious Diseases, Milan, Italy
| | - Martina Ranzenigo
- San Raffaele Vita-Salute University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Department of Infectious Diseases, Milan, Italy
| | - Alessandra Marzi
- IRCCS San Raffaele Scientific Institute, Department of Cardiac Electrophysiology, Milan, Italy
| | - Chiara Oltolini
- IRCCS San Raffaele Scientific Institute, Department of Infectious Diseases, Milan, Italy
| | - Chiara Tassan Din
- IRCCS San Raffaele Scientific Institute, Department of Infectious Diseases, Milan, Italy
| | - Caterina Uberti-Foppa
- San Raffaele Vita-Salute University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Department of Infectious Diseases, Milan, Italy
| | - Vincenzo Spagnuolo
- IRCCS San Raffaele Scientific Institute, Department of Infectious Diseases, Milan, Italy
| | - Patrizio Mazzone
- IRCCS San Raffaele Scientific Institute, Department of Cardiac Electrophysiology, Milan, Italy
| | - Paolo Della Bella
- IRCCS San Raffaele Scientific Institute, Department of Cardiac Electrophysiology, Milan, Italy
| | - Paolo Scarpellini
- IRCCS San Raffaele Scientific Institute, Department of Infectious Diseases, Milan, Italy
| | - Antonella Castagna
- San Raffaele Vita-Salute University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Department of Infectious Diseases, Milan, Italy
| | - Marco Ripa
- San Raffaele Vita-Salute University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Department of Infectious Diseases, Milan, Italy.
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Oliveira GB, Fae IG, Carvalho VT, Pinto PHOM, Duque RAS, Gelape FA, Cambraia FSL, Costa GL, Diamante LC, Bráulio R, Gelape CL, Sousa MR, Ferrari TCA, Nunes MCP. Predictors of Mortality in Patients with Cardiac Device-Related Infective Endocarditis. Trop Med Infect Dis 2024; 9:193. [PMID: 39330882 PMCID: PMC11436160 DOI: 10.3390/tropicalmed9090193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2024] [Revised: 08/15/2024] [Accepted: 08/20/2024] [Indexed: 09/28/2024] Open
Abstract
Infective endocarditis (IE) associated with implantable cardiac devices (ICD) is a serious disease with high mortality rates. The increased number of ICD implants has led to increased ICD infection rates. The aim of this study was to characterize clinical, laboratory profiles and the prognosis of cardiac-device-related endocarditis (CDIE), as well as to identify predictors of in-hospital death. A total of 274 patients with IE were included in a prospective cohort (2007-2019). From these, 82 patients (30%) had CDIE (46 pacemakers, 23 cardioverter defibrillators, and 13 cardiac resynchronization therapy devices). Predisposed conditions; clinical, laboratory and echocardiographic parameters; etiologic agents; and in-hospital outcomes were evaluated. The mean age was 55.8 ± 16.4 years, where 64.6% were male. Among the clinical manifestations at diagnosis, the most prevalent were heart failure (67.9%), fever (60.5%), anorexia/hyporexia (44.4%), and heart murmur (37.5%). The median serum C-reactive protein (CRP) level at diagnosis was 63 mg/L (interquartile range [IQR] 20-161). Etiological agents were identified through positive blood cultures in 55% of cases. The main etiologic agents were negative-coagulase staphylococci (19.5%) and Staphylococcus aureus (18.3%). Vegetation was identified in 74 patients (90.1%). In-hospital mortality was 28%. CRP concentrations at diagnosis were identified as markers of disease severity (odds ratio [OR] 1.006; 95%CI 1.001-1.011; p = 0.016), and the worsening of heart failure was associated with unfavorable outcomes (OR 3.105; 95%CI 1.397-6.902; p = 0.005). Unlike what is traditionally accepted, CDIE does not have a better prognosis.
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Affiliation(s)
- Gustavo Brandão Oliveira
- Programa de Pós-Graduação em Ciências Aplicadas à Saúde do Adulto, Faculdade de Medicina da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte 30130-100, MG, Brazil; (G.B.O.); (I.G.F.); (P.H.O.M.P.); (T.C.A.F.)
| | - Isabela Galizzi Fae
- Programa de Pós-Graduação em Ciências Aplicadas à Saúde do Adulto, Faculdade de Medicina da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte 30130-100, MG, Brazil; (G.B.O.); (I.G.F.); (P.H.O.M.P.); (T.C.A.F.)
| | - Vinícius Tostes Carvalho
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte 30130-100, MG, Brazil; (V.T.C.); (F.S.L.C.); (G.L.C.); (L.C.D.)
| | - Pedro Henrique Oliveira Murta Pinto
- Programa de Pós-Graduação em Ciências Aplicadas à Saúde do Adulto, Faculdade de Medicina da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte 30130-100, MG, Brazil; (G.B.O.); (I.G.F.); (P.H.O.M.P.); (T.C.A.F.)
| | - Roni Arley Silva Duque
- Hospital das Clínicas da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 110, Santa Efigênia, Belo Horizonte 30130-100, MG, Brazil; (R.A.S.D.); (M.R.S.)
| | - Fernanda Alves Gelape
- Faculdade de Ciências Médicas de Minas Gerais, Alameda Ezequiel Dias, 275, Centro, Belo Horizonte 30130-110, MG, Brazil;
| | - Fernanda Sophya Leite Cambraia
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte 30130-100, MG, Brazil; (V.T.C.); (F.S.L.C.); (G.L.C.); (L.C.D.)
| | - Guilherme Lelis Costa
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte 30130-100, MG, Brazil; (V.T.C.); (F.S.L.C.); (G.L.C.); (L.C.D.)
| | - Lucas Chaves Diamante
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte 30130-100, MG, Brazil; (V.T.C.); (F.S.L.C.); (G.L.C.); (L.C.D.)
| | - Renato Bráulio
- Departamento de Cirurgia, Faculdade de Medicina da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte 30130-100, MG, Brazil; (R.B.); (C.L.G.)
| | - Cláudio Léo Gelape
- Departamento de Cirurgia, Faculdade de Medicina da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte 30130-100, MG, Brazil; (R.B.); (C.L.G.)
| | - Marcos Roberto Sousa
- Hospital das Clínicas da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 110, Santa Efigênia, Belo Horizonte 30130-100, MG, Brazil; (R.A.S.D.); (M.R.S.)
| | - Teresa Cristina Abreu Ferrari
- Programa de Pós-Graduação em Ciências Aplicadas à Saúde do Adulto, Faculdade de Medicina da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte 30130-100, MG, Brazil; (G.B.O.); (I.G.F.); (P.H.O.M.P.); (T.C.A.F.)
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte 30130-100, MG, Brazil; (V.T.C.); (F.S.L.C.); (G.L.C.); (L.C.D.)
| | - Maria Carmo Pereira Nunes
- Programa de Pós-Graduação em Ciências Aplicadas à Saúde do Adulto, Faculdade de Medicina da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte 30130-100, MG, Brazil; (G.B.O.); (I.G.F.); (P.H.O.M.P.); (T.C.A.F.)
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte 30130-100, MG, Brazil; (V.T.C.); (F.S.L.C.); (G.L.C.); (L.C.D.)
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Deer TR, Russo MA, Sayed D, Pope JE, Grider JS, Hagedorn JM, Falowski SM, Al-Kaisy A, Slavin KV, Li S, Poree LR, Eldabe S, Meier K, Lamer TJ, Pilitsis JG, De Andrés J, Perruchoud C, Carayannopoulos AG, Moeschler SM, Hadanny A, Lee E, Varshney VP, Desai MJ, Pahapill P, Osborn J, Bojanic S, Antony A, Piedimonte F, Hayek SM, Levy RM. The Neurostimulation Appropriateness Consensus Committee (NACC)®: Recommendations for the Mitigation of Complications of Neurostimulation. Neuromodulation 2024; 27:977-1007. [PMID: 38878054 DOI: 10.1016/j.neurom.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/27/2024] [Accepted: 04/08/2024] [Indexed: 08/09/2024]
Abstract
INTRODUCTION The International Neuromodulation Society convened a multispecialty group of physicians based on expertise and international representation to establish evidence-based guidance on the mitigation of neuromodulation complications. This Neurostimulation Appropriateness Consensus Committee (NACC)® project intends to update evidence-based guidance and offer expert opinion that will improve efficacy and safety. MATERIALS AND METHODS Authors were chosen on the basis of their clinical expertise, familiarity with the peer-reviewed literature, research productivity, and contributions to the neuromodulation literature. Section leaders supervised literature searches of MEDLINE, BioMed Central, Current Contents Connect, Embase, International Pharmaceutical Abstracts, Web of Science, Google Scholar, and PubMed from 2017 (when NACC last published guidelines) to October 2023. Identified studies were graded using the United States Preventive Services Task Force criteria for evidence and certainty of net benefit. Recommendations are based on the strength of evidence or consensus when evidence was scant. RESULTS The NACC examined the published literature and established evidence- and consensus-based recommendations to guide best practices. Additional guidance will occur as new evidence is developed in future iterations of this process. CONCLUSIONS The NACC recommends best practices regarding the mitigation of complications associated with neurostimulation to improve safety and efficacy. The evidence- and consensus-based recommendations should be used as a guide to assist decision-making when clinically appropriate.
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Affiliation(s)
- Timothy R Deer
- The Spine and Nerve Center of the Virginias, Charleston, WV, USA.
| | | | - Dawood Sayed
- The University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Jay S Grider
- UKHealthCare Pain Services, Department of Anesthesiology, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Jonathan M Hagedorn
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Adnan Al-Kaisy
- Guy's and St. Thomas National Health Service (NHS) Foundation Trust, The Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - Konstantin V Slavin
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA; Neurology Section, Jesse Brown Veterans Administration Medical Center, Chicago, IL, USA
| | - Sean Li
- National Spine & Pain Centers, Shrewsbury, NJ, USA
| | - Lawrence R Poree
- Department of Anesthesia and Perioperative Care, University of California at San Francisco, San Francisco, CA, USA
| | - Sam Eldabe
- The James Cook University Hospital, Middlesbrough, UK
| | - Kaare Meier
- Department of Anesthesiology (OPINord), Aarhus University Hospital, Aarhus, Arhus, Denmark; Department of Neurosurgery (Afd. NK), Aarhus University Hospital, Aarhus, Arhus, Denmark
| | | | | | - Jose De Andrés
- Valencia School of Medicine, Anesthesia Critical Care and Pain Management Department, General University Hospital, Valencia, Spain
| | | | - Alexios G Carayannopoulos
- Department of Physical Medicine and Rehabilitation and Comprehensive Spine Center, Rhode Island Hospital, Providence, RI, USA; Brown University Warren Alpert Medical School (Neurosurgery), Providence, RI, USA
| | - Susan M Moeschler
- Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Amir Hadanny
- Department of Neurosurgery, Albany Medical College, Albany, NY, USA
| | - Eric Lee
- Mililani Pain Center, Mililani, HI, USA
| | - Vishal P Varshney
- Anesthesiology and Pain Medicine, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Mehul J Desai
- International Spine, Pain & Performance Center, Virginia Hospital Center, Monument Research Institute, George Washington University School of Medicine, Arlington, VA, USA
| | - Peter Pahapill
- Functional Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - J Osborn
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Stana Bojanic
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Ajay Antony
- The Orthopaedic Institute, Gainesville, FL, USA
| | - Fabian Piedimonte
- School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Salim M Hayek
- Case Western Reserve University, University Hospitals of Cleveland, Cleveland, OH, USA
| | - Robert M Levy
- Neurosurgical Services, Clinical Research, Anesthesia Pain Care Consultants, Tamarac, FL, USA
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Yousuf O, Lee J(J, Atwater BD. Case Report: Leadless and left bundle branch area pacemakers, complementary advantages require a personalized approach. Front Cardiovasc Med 2024; 11:1373884. [PMID: 39139752 PMCID: PMC11320998 DOI: 10.3389/fcvm.2024.1373884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 05/16/2024] [Indexed: 08/15/2024] Open
Abstract
Traditional transvenous pacemakers consist of a pacemaker generator usually positioned surgically in the upper left chest on the pectoral muscle fascia and one or more leads positioned through the veins to the right atrium and across the tricuspid valve to the right ventricular apex. While these devices reduce symptoms and improve survival among patients with symptomatic bradycardia, they are associated with an increased risk of infection, venous occlusion, heart failure, and tricuspid valve regurgitation. Although new pacemaker designs minimize these risks, none of the current-generation pacemaker designs effectively eliminate all of them. A personalized approach to selecting the appropriate pacemaker for each patient is needed to optimize outcomes.
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Affiliation(s)
- Omair Yousuf
- Carient Heart & Vascular, Vienna, VA, United States
- University of Virginia Health, Manassas, VA, United States
- Inova Schar Heart and Vascular, Inova Health System, Falls Church, VA, United States
| | - Jae (Jeff) Lee
- Inova Schar Heart and Vascular, Inova Health System, Falls Church, VA, United States
- Virginia Heart, Fairfax, VA, United States
| | - Brett D. Atwater
- Inova Schar Heart and Vascular, Inova Health System, Falls Church, VA, United States
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Modi RM, Cruz Marquez ML, Yang S, D’Angelo RN, Maher TR, Kreidieh B, Palmeri NO, Stabenau HF, Goldense D, Wacks E, Tung P, d’Avila A, Waks J, Zimetbaum P, Locke AH. Utility of an Externalized Temporary Transvenous Implantable Cardioverter-defibrillator System in the Setting of Ventricular Tachycardia Storm and Concurrent Device Infection Requiring Extraction. J Innov Card Rhythm Manag 2024; 15:5930-5934. [PMID: 39011464 PMCID: PMC11238887 DOI: 10.19102/icrm.2024.15071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 02/28/2024] [Indexed: 07/17/2024] Open
Abstract
With the expanding use of cardiac implantable electronic device (CIED) therapy, intravascular device infections are becoming more common. In the case of transvenous implantable cardioverter-defibrillator (ICD) infections requiring extraction for bacterial clearance, there remains no standard method to deliver temporary ICD therapy following device removal. We present a case of persistent bacteremia complicated by monomorphic ventricular tachycardia (VT) electrical storm where biventricular ICD system extraction was performed and a temporary transvenous dual-coil lead with an externalized ICD generator was used to treat VT episodes prior to the re-implantation of a new permanent system. This case demonstrates the utility of a temporary externalized transvenous ICD system in the successful detection and pace-termination of VT, thereby reducing episodes of painful and potentially harmful external defibrillator shocks during the treatment of CIED infection.
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Affiliation(s)
- Ronuk M. Modi
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Shu Yang
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Robert N. D’Angelo
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Timothy R. Maher
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Bahij Kreidieh
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Hans F. Stabenau
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Dana Goldense
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Emily Wacks
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Patricia Tung
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Andre d’Avila
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jonathan Waks
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Peter Zimetbaum
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Andrew H. Locke
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Agarwal S, Qamar U, Munir MB, Asad ZUA, Deshmukh A, DeSimone DC, DeSimone CV. Trends and disparities in cardiac implantable electronic device infection-related mortality in the United States. J Cardiovasc Electrophysiol 2024; 35:1487-1489. [PMID: 38725220 DOI: 10.1111/jce.16298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/23/2024] [Accepted: 04/28/2024] [Indexed: 07/12/2024]
Abstract
INTRODUCTION We performed a cross-sectional study using the Centers for Disease Control and Prevention's (CDC's) Wide-Ranging Online Data for Epidemiologic Research (WONDER) database to analyze the trends in cardiac implantable electronic device (CIED) infection-related mortality from 1999 to 2020. METHODS We analyzed the death certificate data from the CDC WONDER database from 1999 to 2020 for CIED infections in the US population aged ≥25 years using International Classification of Diseases, Tenth Revision (ICD-10) codes, listed as the underlying or contributing cause of death. Age-adjusted mortality rates (AAMR) and 95% confidence intervals (CIs) were computed per 1 million population by standardizing crude mortality rates to the 2000 US census population. To assess annual mortality trends, we employed the Joinpoint regression model, calculating the annual percent change (APC) in AAMR and corresponding 95% CIs. RESULTS Overall, there was an observed declining trend in AAMRs related to CIED infection-related mortality. Males accounted for 55% of the total deaths, with persistently higher AAMRs compared to females over the study duration. Both males and females had an overall decreasing trend in AAMRs throughout the study duration. On race/ethnicity stratified analysis, non-Hispanic (NH) Blacks exhibited the highest overall AAMR, followed by NH American Indians or Alaska Natives, NH Whites, Hispanic or Latinos, and NH Asian or Pacific Islanders. On a stratified analysis based on region, the South region had the highest overall AAMR, followed by the Midwest, West, and Northeast regions. CONCLUSION Our study demonstrates a significant decline in CIED infection-related mortality in patients over the last two decades. Notable gender, racial/ethnic, and regional differences exist in the rates of mortality related to CIED infections.
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Affiliation(s)
- Siddharth Agarwal
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Usama Qamar
- Department of Medicine, King Edward Medical University, Lahore, Pakistan
| | - Muhammad Bilal Munir
- Division of Cardiovascular Medicine, University of California Davis, Sacramento, California, USA
| | - Zain Ul Abideen Asad
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Abhishek Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel C DeSimone
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Schipmann LC, Moeller V, Krimnitz J, Bannehr M, Kramer TS, Haase-Fielitz A, Butter C. Outcome and microbiological findings of patients with cardiac implantable electronic device infection. Heart Vessels 2024; 39:626-639. [PMID: 38512486 DOI: 10.1007/s00380-024-02380-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/21/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION Infections associated with cardiac implantable electronic devices (CIEDs) are a multifactorial disease that leads to increased morbidity and mortality. OBJECTIVE The aim was to analyze patient-, disease- and treatment-related characteristics including microbiological and bacterial spectrum according to survival status and to identify risk factors for 1- and 3-year mortality in patients with local and systemic CIED infection. METHODS In a retrospective cohort study, we analyzed data from patients with CIED-related local or systemic infection undergoing successful transvenous lead extraction (TLE). Survival status as well as incidence and cause of rehospitalization were recorded. Microbiology and antibiotics used as first-line therapy were compared according to mortality. Independent risk factors for 1- and 3-year mortality were determined. RESULTS Data from 243 Patients were analyzed. In-hospital mortality was 2.5%. Mortality rates at 30 days, 1- and 3 years were 4.1%, 18.1% and 30%, respectively. Seventy-four (30.5%) patients had systemic bacterial infection. Independent risk factors for 1-year mortality included age (OR 1.05 [1.01-1.10], p = 0.014), NT-proBNP at admission (OR 4.18 [1.81-9.65], p = 0.001), new onset or worsened tricuspid regurgitation after TLE (OR 6.04 [1.58-23.02], p = 0.009), and systemic infection (OR 2.76 [1.08-7.03], p = 0.034), whereas systemic infection was no longer an independent risk factor for 3-year mortality. Staphylococcus aureus was found in 18.1% of patients who survived and in 25% of those who died, p = 0.092. There was a high proportion of methicillin-resistant strains among coagulase-negative staphylococci (16.5%) compared to Staphylococcus aureus (1.2%). CONCLUSIONS Staphylococci are the most common causative germs of CIED-infection with coagulase-negative staphylococci showing higher resistance rates to antibiotics. The independent risk factors for increased long-term mortality could contribute to individual risk stratification and well-founded treatment decisions in clinical routine. Especially the role of tricuspid regurgitation as a complication after TLE should be investigated in future studies.
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Affiliation(s)
- Lara C Schipmann
- Department of Cardiology, Faculty of Health Sciences (FGW) Brandenburg, Heart Center Brandenburg Bernau, Brandenburg Medical School (MHB) Theodor Fontane, Ladeburger Straße 17, 16321, Bernau Bei Berlin, Germany.
- Department of Internal Medicine, Cardiology, Nephrology and Diabetology, Protestant Hospital of Bethel Foundation, University Hospital OWL, University of Bielefeld, Campus Bielefeld-Bethel, Bielefeld, Germany.
| | - Viviane Moeller
- Department of Cardiology, Faculty of Health Sciences (FGW) Brandenburg, Heart Center Brandenburg Bernau, Brandenburg Medical School (MHB) Theodor Fontane, Ladeburger Straße 17, 16321, Bernau Bei Berlin, Germany
| | - Juliane Krimnitz
- Department of Cardiology, Faculty of Health Sciences (FGW) Brandenburg, Heart Center Brandenburg Bernau, Brandenburg Medical School (MHB) Theodor Fontane, Ladeburger Straße 17, 16321, Bernau Bei Berlin, Germany
| | - Marwin Bannehr
- Department of Cardiology, Faculty of Health Sciences (FGW) Brandenburg, Heart Center Brandenburg Bernau, Brandenburg Medical School (MHB) Theodor Fontane, Ladeburger Straße 17, 16321, Bernau Bei Berlin, Germany
| | - Tobias Siegfried Kramer
- LADR MVZ GmbH Neuruppin, Zur Mesche 20, 16816, Neuruppin, Germany
- LADR Zentrallabor Dr. Kramer & Kollegen, Geesthacht, Germany
| | - Anja Haase-Fielitz
- Department of Cardiology, Faculty of Health Sciences (FGW) Brandenburg, Heart Center Brandenburg Bernau, Brandenburg Medical School (MHB) Theodor Fontane, Ladeburger Straße 17, 16321, Bernau Bei Berlin, Germany
- Institute of Social Medicine and Health System Research, Otto Von Guericke University Magdeburg, 39120, Magdeburg, Germany
| | - Christian Butter
- Department of Cardiology, Faculty of Health Sciences (FGW) Brandenburg, Heart Center Brandenburg Bernau, Brandenburg Medical School (MHB) Theodor Fontane, Ladeburger Straße 17, 16321, Bernau Bei Berlin, Germany
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9
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Matteucci A, Pignalberi C, Pandozi C, Magris B, Meo A, Russo M, Galeazzi M, Schiaffini G, Aquilani S, Di Fusco SA, Colivicchi F. Prevention and Risk Assessment of Cardiac Device Infections in Clinical Practice. J Clin Med 2024; 13:2707. [PMID: 38731236 PMCID: PMC11084741 DOI: 10.3390/jcm13092707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 04/28/2024] [Accepted: 05/01/2024] [Indexed: 05/13/2024] Open
Abstract
The implantation of cardiac electronic devices (CIEDs), including pacemakers and defibrillators, has become increasingly prevalent in recent years and has been accompanied by a significant rise in cardiac device infections (CDIs), which pose a substantial clinical and economic burden. CDIs are associated with hospitalizations and prolonged antibiotic therapy and often necessitate device removal, leading to increased morbidity, mortality, and healthcare costs worldwide. Approximately 1-2% of CIED implants are associated with infections, making this a critical issue to address. In this contemporary review, we discuss the burden of CDIs with their risk factors, healthcare costs, prevention strategies, and clinical management.
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Affiliation(s)
- Andrea Matteucci
- Clinical and Rehabilitation Cardiology Division, San Filippo Neri Hospital, 00135 Rome, Italy
- Department of Experimental Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Carlo Pignalberi
- Clinical and Rehabilitation Cardiology Division, San Filippo Neri Hospital, 00135 Rome, Italy
| | - Claudio Pandozi
- Clinical and Rehabilitation Cardiology Division, San Filippo Neri Hospital, 00135 Rome, Italy
| | - Barbara Magris
- Clinical and Rehabilitation Cardiology Division, San Filippo Neri Hospital, 00135 Rome, Italy
| | - Antonella Meo
- Clinical and Rehabilitation Cardiology Division, San Filippo Neri Hospital, 00135 Rome, Italy
| | - Maurizio Russo
- Clinical and Rehabilitation Cardiology Division, San Filippo Neri Hospital, 00135 Rome, Italy
| | - Marco Galeazzi
- Clinical and Rehabilitation Cardiology Division, San Filippo Neri Hospital, 00135 Rome, Italy
| | - Giammarco Schiaffini
- Clinical and Rehabilitation Cardiology Division, San Filippo Neri Hospital, 00135 Rome, Italy
| | - Stefano Aquilani
- Clinical and Rehabilitation Cardiology Division, San Filippo Neri Hospital, 00135 Rome, Italy
| | | | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Division, San Filippo Neri Hospital, 00135 Rome, Italy
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10
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Carretero EG, de Alarcón González A, de la Borbolla MG, Ciriza GG, Herrera V, Rueda EA, Pedrote A, Smani T, Fernández AO, Pérez IV. Infections of cardiac implantable electronic devices and how to improve transvenous lead extraction by the virtual reality. Indian J Thorac Cardiovasc Surg 2024; 40:138-149. [PMID: 38827540 PMCID: PMC11139837 DOI: 10.1007/s12055-023-01663-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/22/2023] [Accepted: 11/22/2023] [Indexed: 06/04/2024] Open
Abstract
Introduction Infections in cardiac implantable electronic devices (CIED) are increasing over time and associated with substantially mortality and healthcare costs. The best approach is the complete removal of the system by transvenous lead extraction (TLE). However, when leads are more than 10 years old, this technique requires considerable expertise and failures with the result of abandoned leads or serious complications may occur. The aim of this study is to describe our experience using virtual and mixed reality in the preoperative planning of complex cases. Patients and methods Consecutive patients from a referral centre with CIED infections in which TLE was judged difficult. Synchronized computed tomography (CT) scan images were processed and transferred to a fully immersive virtual reality room and also to the operative room (mixed reality) for better guidance during the extracting procedure. Results Ten patients (seven with local and three with systemic infections) were preoperative evaluated. Processed images and virtual reality showed intense adherences of the leads to the veins, right ventricle, and right atrium endocardium and between them that preclude a difficult extraction and required a carefully planning and sometimes a different technical approach. The anticipated difficulty was confirmed by the higher times of fluoroscopy. All leads were extracted and no complications were registered. Conclusions Preoperative planning is essential for evaluation of TLE difficulty and prevention of unexpected situations. Virtual reality seems an estimable aid for operators in planning difficult cases and also an excellent tool for teaching. Supplementary information The online version contains supplementary material available at 10.1007/s12055-023-01663-9.
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Affiliation(s)
- Encarnación Gutiérrez Carretero
- Department of Cardiovascular Surgery, Hospital Virgen Del Rocio, Av Manuel Siurot S/N 41013, Seville, Spain
- Department of Surgery, School of Medicine, University of Seville, Seville, Spain
- Cardiovascular Pathophysiology Group, Fabrication Laboratory, Institute of Biomedicine of Seville-IBiS, University of Seville, HUVR/CSIC, Seville, Spain
| | - Arístides de Alarcón González
- Clinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville, CSIC/University Hospital Virgen del Rocío, Seville, Spain
| | | | - Gorka Gómez Ciriza
- Cardiovascular Pathophysiology Group, Fabrication Laboratory, Institute of Biomedicine of Seville-IBiS, University of Seville, HUVR/CSIC, Seville, Spain
| | | | | | - Alonso Pedrote
- Department of Cardiology, Hospital Virgen Del Rocio, Seville, Spain
| | - Tarik Smani
- Cardiovascular Pathophysiology Group, Fabrication Laboratory, Institute of Biomedicine of Seville-IBiS, University of Seville, HUVR/CSIC, Seville, Spain
| | - Antonio Ordoñez Fernández
- Cardiovascular Pathophysiology Group, Fabrication Laboratory, Institute of Biomedicine of Seville-IBiS, University of Seville, HUVR/CSIC, Seville, Spain
| | - Israel Valverde Pérez
- Cardiovascular Pathophysiology Group, Fabrication Laboratory, Institute of Biomedicine of Seville-IBiS, University of Seville, HUVR/CSIC, Seville, Spain
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
- Department of Paediatrics, School of Medicine, University of Seville, Seville,, Spain
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11
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Poposka L, Risteski D, Cvetkovski D, Pocesta B, Janusevski F, Zimbakov Z, Trajkov I, Stefanovski D, Logar M, Ksela J. Stepwise transvenous lead extraction due to pacemaker pocket infection following lactational mastitis complicated with breast abscess. Int Breastfeed J 2024; 19:27. [PMID: 38641819 PMCID: PMC11027399 DOI: 10.1186/s13006-024-00633-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 04/04/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Lactational mastitis is a common painful and debilitating inflammation of breast tissue, generally treated conservatively or with pus puncture in case of breast abscess. However, treating mastitis in patients with implantable surgical material located in the affected breast region can be extremely challenging. We present an unusual case of lactational mastitis complicated by pacemaker pocket infection in a breastfeeding mother. CASE PRESENTATION A 35-year-old pacemaker-dependent female developed lactational mastitis seven weeks postpartum. Initially, the condition was treated conservatively with analgesics and antibiotics. After abscess formation, pus was aspirated using fine-needle aspiration technique. Four weeks after mastitis resolution, pacemaker pocket infection developed. According to current cardiovascular implantable electronic device infection treatment guidelines a complete surgical extraction of the entire electronic system, followed by targeted antibiotic treatment and reimplantation of a new device after infection resolution, was recommended. However, after thorough discussion with the young woman and her family and after detailed review of surgery-related risks, she declined a potentially high-risk surgical procedure. Thus, only the pulse generator was explanted; pacing leads positioned in the sub-pectoral pocket; new pacemaker implanted on the contralateral side and broad-spectrum antibiotic therapy continued for six weeks. After breastfeeding cessation, and with chronic fistula development at the primary pacemaker implantation site, the possibility of delayed surgical intervention including complete extraction of retained pacemaker leads was again thoroughly discussed with her. After thoughtful consideration the woman consented to the proposed treatment strategy. A surgical procedure including transvenous lead extraction through the primary implantation venous entry site, using hand-powered bidirectional rotational sheaths, was successfully performed, removing all retained leads through the left subclavian venous entry site, and leaving the fully functional and clinically uninfected pacemaker on the contralateral site intact. CONCLUSION Although patients' decisions for delayed extraction in a case of cardiovascular implantable electronic device infection should be discouraged by attending physicians and members of interdisciplinary teams, our case shows that a stepwise treatment strategy may be successful as a bailout clinical scenario in patients with specific requests, demands and / or clinical needs.
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Affiliation(s)
- Lidija Poposka
- University Clinic for Cardiology, Skopje, North Macedonia
- Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Skopje, North Macedonia
| | - Dejan Risteski
- University Clinic for Cardiology, Skopje, North Macedonia
| | | | - Bekim Pocesta
- University Clinic for Cardiology, Skopje, North Macedonia
| | | | - Zhan Zimbakov
- University Clinic for Cardiology, Skopje, North Macedonia
| | - Ivan Trajkov
- Clinical hospital "Acibadem Sistina" Skopje, Skopje, North Macedonia
| | - Dime Stefanovski
- Department of Cardiovascular Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Mateja Logar
- Clinic of Infectious Diseases and Febrile Illnesses, University Medical Center Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Jus Ksela
- Department of Cardiovascular Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia.
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
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12
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Chesdachai S, Esquer Garrigos Z, DeSimone CV, DeSimone DC, Baddour LM. Infective Endocarditis Involving Implanted Cardiac Electronic Devices: JACC Focus Seminar 1/4. J Am Coll Cardiol 2024; 83:1326-1337. [PMID: 38569763 DOI: 10.1016/j.jacc.2023.11.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/26/2023] [Accepted: 11/13/2023] [Indexed: 04/05/2024]
Abstract
Cardiac implantable electronic device-related infective endocarditis (CIED-IE) encompasses a range of clinical syndromes, including valvular, device lead, and bloodstream infections. However, accurately diagnosing CIED-IE remains challenging owing in part to diverse clinical presentations, lack of standardized definition, and variations in guideline recommendations. Furthermore, current diagnostic modalities, such as transesophageal echocardiography and [18F]-fluorodeoxyglucose positron emission tomography-computed tomography have limited sensitivity and specificity, further contributing to diagnostic uncertainty. This can potentially result in complications and unnecessary costs associated with inappropriate device extraction. Six hypothetical clinical cases that exemplify the diverse manifestations of CIED-IE are addressed herein. Through these cases, we highlight the importance of optimizing diagnostic accuracy and stewardship, understanding different pathogen-specific risks for bloodstream infections, guiding appropriate device extraction, and preventing CIED-IE, all while addressing key knowledge gaps. This review both informs clinicians and underscores crucial areas for future investigation, thereby shedding light on this complex and challenging syndrome.
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Affiliation(s)
- Supavit Chesdachai
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
| | - Zerelda Esquer Garrigos
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA; Division of Infectious Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - Daniel C DeSimone
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Larry M Baddour
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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13
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Özkartal T, Demarchi A, Conte G, Pongan D, Klersy C, Caputo ML, Bergonti M, Bernasconi E, Gaia V, Granger CB, Auricchio A. Cardiac implantable electronic devices and bloodstream infections: management and outcomes. Eur Heart J 2024; 45:1269-1277. [PMID: 38546408 PMCID: PMC10998729 DOI: 10.1093/eurheartj/ehae127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 01/18/2024] [Accepted: 02/15/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND AND AIMS Bloodstream infection (BSI) of any cause may lead to device infection in cardiac implantable electronic device (CIED) patients. Aiming for a better understanding of the diagnostic approach, treatment, and outcome, patients with an implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy and defibrillator (CRT-D) hospitalized with BSI were investigated. METHODS This is a single-centre, retrospective, cohort analysis including consecutive ICD/CRT-D patients implanted between 2012 and 2021. These patients were screened against a list of all hospitalized patients having positive blood cultures consistent with diagnosed infection in any department of a local public hospital. RESULTS The total cohort consisted of 515 patients. Over a median follow-up of 59 months (interquartile range 31-87 months), there were 47 BSI episodes in 36 patients. The majority of patients with BSI (92%) was admitted to non-cardiology units, and in 25 episodes (53%), no cardiac imaging was performed. Nearly all patients (85%) were treated with short-term antibiotics, whereas chronic antibiotic suppression therapy (n = 4) and system extraction (n = 3) were less frequent. Patients with BSI had a nearly seven-fold higher rate (hazard ratio 6.7, 95% confidence interval 3.9-11.2; P < .001) of all-cause mortality. CONCLUSIONS Diagnostic workup of defibrillator patients with BSI admitted to a non-cardiology unit is often insufficient to characterize lead-related endocarditis. The high mortality rate in these patients with BSI may relate to underdiagnosis and consequently late/absence of system removal. Efforts to increase an interdisciplinary approach and greater use of cardiac imaging are necessary for timely diagnosis and adequate treatment.
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Affiliation(s)
- Tardu Özkartal
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete 48, Lugano 6900, Switzerland
| | - Andrea Demarchi
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete 48, Lugano 6900, Switzerland
| | - Giulio Conte
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete 48, Lugano 6900, Switzerland
- Faculty of Biomedical Sciences, University of Southern Switzerland, Lugano, Switzerland
| | - Damiano Pongan
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete 48, Lugano 6900, Switzerland
| | - Catherine Klersy
- Biostatistics and Clinical Trial Center, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Maria Luce Caputo
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete 48, Lugano 6900, Switzerland
| | - Marco Bergonti
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete 48, Lugano 6900, Switzerland
| | - Enos Bernasconi
- Faculty of Biomedical Sciences, University of Southern Switzerland, Lugano, Switzerland
- Internal Medicine, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Faculty of Medicine, Department of Internal Medicine, University of Geneva, Geneva, Switzerland
| | - Valeria Gaia
- Department of Laboratory Medicine, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Christopher B Granger
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Angelo Auricchio
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete 48, Lugano 6900, Switzerland
- Faculty of Biomedical Sciences, University of Southern Switzerland, Lugano, Switzerland
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14
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Jelisejevas J, Regoli F, Hofer D, Conte G, Oezkartal T, Saguner AM, Caputo ML, Grazioli L, Steffel J, Auricchio A, Breitenstein A. Leadless Pacemaker Implantation in Patients With a Prior Conventional Pacing System. CJC Open 2024; 6:649-655. [PMID: 38708054 PMCID: PMC11065736 DOI: 10.1016/j.cjco.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/11/2023] [Indexed: 05/07/2024] Open
Abstract
Background Leadless pacing has been established as an alternative approach to transvenous devices for selected patients. Often, leadless pacemaker (LP) implantation is a de novo procedure, but in an increasing number of patients, an LP is used after previous implantation of a conventional pacing system (CPS). Methods A retrospective analysis was conducted of the efficacy and safety of LP implantation in the context of a previously implanted CPS, from 2 large Swiss centres. Results A total of 257 consecutive patients undergoing LP implantation were included. They were divided into 2 groups: group 1 consisted of 233 patients who did not have a previous CPS, and group 2 consisted of 24 patients with an in situ CPS. In group 2, a total of 20 patients (83%) required transvenous lead extraction due to infection, malfunction, or other reasons. In 3 patients with device-related infection, lead extraction and LP implantation was performed as a single procedure, whereas in the remaining 11 cases, a time window occurred between the 2 procedures (median: 11.5 days; range: 2-186 days). Electrical device parameters at implantation and during follow-up did not differ between the 2 groups (mean: 12.5 ± 9.3 months). Eight major periprocedural complications (3.1%) were encountered (4 pericardial effusions, 3 instances of femoral bleeding, and 1 instance of intra-abdominal bleeding) in the entire cohort within a 30-day period. No complications occurred in the group with a previous device. No infections were registered, even when complete extraction of an infected CPS was performed prior to LP implantation. Conclusions Implantation of an LP in patients with a prior CPS (with or without extraction of the previous system) was effective and safe in our population of patients.
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Affiliation(s)
- Julius Jelisejevas
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - François Regoli
- Fondazione Cardiocentro Ticino, Lugano, Switzerland
- Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Daniel Hofer
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Giulio Conte
- Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | | | - Ardan M. Saguner
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | | | | | - Jan Steffel
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
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15
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Maclean E, Mahtani K, Honarbakhsh S, Butcher C, Ahluwalia N, Dennis AS, Creta A, Finlay M, Elliott M, Mehta V, Wijesuriya N, Shaikh O, Zaw Y, Ogbedeh C, Gautam V, Lambiase PD, Schilling RJ, Earley MJ, Moore P, Muthumala A, Sporton SC, Hunter RJ, Rinaldi CA, Behar J, Martin C, Monkhouse C, Chow A. The BLISTER Score: A Novel, Externally Validated Tool for Predicting Cardiac Implantable Electronic Device Infections, and Its Cost-Utility Implications for Antimicrobial Envelope Use. Circ Arrhythm Electrophysiol 2024; 17:e012446. [PMID: 38258308 PMCID: PMC10949977 DOI: 10.1161/circep.123.012446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/18/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND Antimicrobial envelopes reduce the incidence of cardiac implantable electronic device infections, but their cost restricts routine use in the United Kingdom. Risk scoring could help to identify which patients would most benefit from this technology. METHODS A novel risk score (BLISTER [Blood results, Long procedure time, Immunosuppressed, Sixty years old (or younger), Type of procedure, Early re-intervention, Repeat procedure]) was derived from multivariate analysis of factors associated with cardiac implantable electronic device infection. Diagnostic utility was assessed against the existing PADIT score (Prior procedure, Age, Depressed renal function, Immunocompromised, Type of procedure) in both standard and high-risk external validation cohorts, and cost-utility models examined different BLISTER and PADIT score thresholds for TYRX (Medtronic; Minneapolis, MN) antimicrobial envelope allocation. RESULTS In a derivation cohort (n=7383), cardiac implantable electronic device infection occurred in 59 individuals within 12 months of a procedure (event rate, 0.8%). In addition to the PADIT score constituents, lead extraction (hazard ratio, 3.3 [95% CI, 1.9-6.1]; P<0.0001), C-reactive protein >50 mg/L (hazard ratio, 3.0 [95% CI, 1.4-6.4]; P=0.005), reintervention within 2 years (hazard ratio, 10.1 [95% CI, 5.6-17.9]; P<0.0001), and top-quartile procedure duration (hazard ratio, 2.6 [95% CI, 1.6-4.1]; P=0.001) were independent predictors of infection. The BLISTER score demonstrated superior discriminative performance versus PADIT in the standard risk (n=2854, event rate: 0.8%, area under the curve, 0.82 versus 0.71; P=0.001) and high-risk validation cohorts (n=1961, event rate: 2.0%, area under the curve, 0.77 versus 0.69; P=0.001), and in all patients (n=12 198, event rate: 1%, area under the curve, 0.8 versus 0.75, P=0.002). In decision-analytic modeling, the optimum scenario assigned antimicrobial envelopes to patients with BLISTER scores ≥6 (10.8%), delivering a significant reduction in infections (relative risk reduction, 30%; P=0.036) within the National Institute for Health and Care Excellence cost-utility thresholds (incremental cost-effectiveness ratio, £18 446). CONCLUSIONS The BLISTER score (https://qxmd.com/calculate/calculator_876/the-blister-score-for-cied-infection) was a valid predictor of cardiac implantable electronic device infection, and could facilitate cost-effective antimicrobial envelope allocation to high-risk patients.
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Affiliation(s)
- Edd Maclean
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom (E.M., S.H., N.A., R.J.S., R.J.H., A. Chow)
| | - Karishma Mahtani
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
| | - Shohreh Honarbakhsh
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom (E.M., S.H., N.A., R.J.S., R.J.H., A. Chow)
| | - Charles Butcher
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
| | - Nikhil Ahluwalia
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom (E.M., S.H., N.A., R.J.S., R.J.H., A. Chow)
| | - Adam S.C. Dennis
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
| | - Antonio Creta
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
| | - Malcolm Finlay
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
| | - Mark Elliott
- Department of Cardiac Electrophysiology, St. Thomas’ Hospital, London, United Kingdom (M.E., V.M., N.W., C.A.R., J.B.)
| | - Vishal Mehta
- Department of Cardiac Electrophysiology, St. Thomas’ Hospital, London, United Kingdom (M.E., V.M., N.W., C.A.R., J.B.)
| | - Nadeev Wijesuriya
- Department of Cardiac Electrophysiology, St. Thomas’ Hospital, London, United Kingdom (M.E., V.M., N.W., C.A.R., J.B.)
| | - Omar Shaikh
- Department of Cardiac Electrophysiology, Royal Papworth Hospital, Cambridge, United Kingdom (O.S., Y.Z., C.O., V.G., C. Martin)
| | - Yom Zaw
- Department of Cardiac Electrophysiology, Royal Papworth Hospital, Cambridge, United Kingdom (O.S., Y.Z., C.O., V.G., C. Martin)
| | - Chizute Ogbedeh
- Department of Cardiac Electrophysiology, Royal Papworth Hospital, Cambridge, United Kingdom (O.S., Y.Z., C.O., V.G., C. Martin)
| | - Vasu Gautam
- Department of Cardiac Electrophysiology, Royal Papworth Hospital, Cambridge, United Kingdom (O.S., Y.Z., C.O., V.G., C. Martin)
| | - Pier D. Lambiase
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
| | - Richard J. Schilling
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom (E.M., S.H., N.A., R.J.S., R.J.H., A. Chow)
| | - Mark J. Earley
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
| | - Philip Moore
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
| | - Amal Muthumala
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
| | - Simon C.E. Sporton
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
| | - Ross J. Hunter
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom (E.M., S.H., N.A., R.J.S., R.J.H., A. Chow)
| | - Christopher A. Rinaldi
- Department of Cardiac Electrophysiology, St. Thomas’ Hospital, London, United Kingdom (M.E., V.M., N.W., C.A.R., J.B.)
| | - Jonathan Behar
- Department of Cardiac Electrophysiology, St. Thomas’ Hospital, London, United Kingdom (M.E., V.M., N.W., C.A.R., J.B.)
| | - Claire Martin
- Department of Cardiac Electrophysiology, Royal Papworth Hospital, Cambridge, United Kingdom (O.S., Y.Z., C.O., V.G., C. Martin)
| | - Christopher Monkhouse
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
| | - Anthony Chow
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom (E.M., S.H., N.A., R.J.S., R.J.H., A. Chow)
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16
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Lakkireddy DR, Rao A, Theriot P, Darden D, Pothineni NVK, Ram R, Gao YR, Cheung JW, Birgersdotter-Green U. Contemporary Management of Cardiac Implantable Electronic Device Infection: The American College of Cardiology COGNITO Survey. JACC. ADVANCES 2024; 3:100773. [PMID: 38939375 PMCID: PMC11198053 DOI: 10.1016/j.jacadv.2023.100773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/14/2023] [Accepted: 10/30/2023] [Indexed: 06/29/2024]
Abstract
Background Cardiac implantable electronic devices (CIEDs) infection remains a serious complication, causing increased morbidity and mortality. Early recognition and escalation to definitive therapy including extraction of the infected device often pose challenges. Objectives The purpose of this study was to assess U.S.-based physicians current practices in diagnosing and managing CIED infections and explore potential extraction barriers. Methods An observational survey was performed by the American College of Cardiology including U.S. physicians managing CIEDs from February to March 2022. Sampling techniques and screener questions determined eligibility. The survey featured questions on knowledge and experience with CIED infection patients and case scenarios. Results Of 387 physicians completing the survey (20% response rate), 49% indicated familiarity with current guidelines regarding CIED infection. Electrophysiologists (EPs) (91%) were more familiar with these guidelines, compared to non-EP cardiologists (29%) and primary care physicians (23%). Only 30% of physicians specified that their institution had guideline-based protocols in place for managing patients with CIED infection. When presented with pocket infection cases, approximately 89% of EPs and 50% of non-EP cardiologists would follow guideline recommendation to do complete CIED system removal, while 70% of primary care physicians did not recommend guideline-directed treatment. Conclusions There are gaps in familiarity of guidelines as well as the knowledge in practical management of CIED infection with non-extracting physicians. Most institutions lack a definite pathway. Addressing discrepancies, including guideline education and streamlining care or referral pathways, will be a key factor to bridging the gap and improving CIED infection patient outcomes.
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Affiliation(s)
| | - Archana Rao
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Paul Theriot
- Enterprise Content & Digital Strategy Division, American College of Cardiology, Washington, DC, USA
| | - Douglas Darden
- Kansas City Heart Rhythm Institute, HCA Midwest, Overland Park, Kansas, USA
| | | | - Rashmi Ram
- Image Guided Therapy, Philips North American, Colorado Springs, Colorado, USA
| | - Yu-Rong Gao
- Image Guided Therapy, Philips North American, Colorado Springs, Colorado, USA
| | - Jim W. Cheung
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York City, New York, USA
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17
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Jelisejevas J, Regoli F, Hofer D, Conte G, Oezkartal T, Saguner AM, Caputo ML, Grazioli L, Steffel J, Auricchio A, Breitenstein A. Leadless Pacemaker Implantation, Focusing on Patients With Conduction System Disorders Post-Transcatheter Aortic Valve Replacement: A Retrospective Analysis. CJC Open 2024; 6:96-103. [PMID: 38585679 PMCID: PMC10994977 DOI: 10.1016/j.cjco.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 10/09/2023] [Indexed: 04/09/2024] Open
Abstract
Background Impairment of the conduction system is a common complication of transcatheter aortic valve replacement (TAVR), which is typically performed in elderly patients. A leadless pacemaker (LP) may be a suitable option in this frail population, but the available scientific data concerning the efficacy and safety of leadless pacing after TAVR are sparse. The purpose of this analysis was to evaluate the efficacy and safety of LP implantation in patients with relevant bradycardias after TAVR, compared to other indications. Methods Consecutive patients were retrospectively enrolled. Demographics, background heart diseases, interventional parameters, and follow-up data were collected. Results A total of 257 consecutive patients who underwent LP implantation were included. In 26 patients, the device was implanted due to bradycardias after TAVR (TAVR group), whereas the remaining 231 patients were in the population without previous TAVR (non-TAVR group). The mean implantation duration (56 ± 22 minutes in the TAVR group vs 48 ± 20 minutes in the non-TAVR group; P = not significant [NS]) and the implantation success rate (100% in the TAVR group vs 98.7% in the non-TAVR group; P = NS) were similar in the 2 cohorts. No significant differences occurred in pacing parameters (sensing, impedance, and threshold, respectively) between the 2 groups, either at implantation or during follow-up. A total of 8 major periprocedural complications (3.1% of patients in total; 3.8% in the TAVR group vs 3.0% in the non-TAVR group; P = NS) occurred within 30 days, without significant difference between the 2 groups. Conclusions LP implantation appears to be safe and effective in patients after TAVR, and therefore, this procedure is a suitable option for this often old and frail population.
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Affiliation(s)
- Julius Jelisejevas
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - François Regoli
- Fondazione Cardiocentro Ticino, Lugano, Switzerland
- Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Daniel Hofer
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Giulio Conte
- Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | | | - Ardan M. Saguner
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | | | | | - Jan Steffel
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
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18
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Ponta G, Ranzenigo M, Marzi A, Oltolini C, Tassan Din C, Uberti-Foppa C, Spagnuolo V, Mazzone P, Della Bella P, Scarpellini P, Castagna A, Ripa M. Is shorter duration of antibiotic treatment feasible in patients with cardiac implantable electronic device infections undergoing device removal? A propensity-adjusted analysis of a 10-year retrospective cohort. Int J Antimicrob Agents 2024; 63:107077. [PMID: 38154658 DOI: 10.1016/j.ijantimicag.2023.107077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/11/2023] [Accepted: 12/21/2023] [Indexed: 12/30/2023]
Affiliation(s)
- Giacomo Ponta
- San Raffaele Vita-Salute University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Department of Infectious Diseases, Milan, Italy.
| | - Martina Ranzenigo
- San Raffaele Vita-Salute University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Department of Infectious Diseases, Milan, Italy
| | - Alessandra Marzi
- IRCCS San Raffaele Scientific Institute, Department of Cardiac Electrophysiology, Milan, Italy
| | - Chiara Oltolini
- IRCCS San Raffaele Scientific Institute, Department of Infectious Diseases, Milan, Italy
| | - Chiara Tassan Din
- IRCCS San Raffaele Scientific Institute, Department of Infectious Diseases, Milan, Italy
| | - Caterina Uberti-Foppa
- San Raffaele Vita-Salute University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Department of Infectious Diseases, Milan, Italy
| | - Vincenzo Spagnuolo
- San Raffaele Vita-Salute University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Department of Infectious Diseases, Milan, Italy
| | - Patrizio Mazzone
- IRCCS San Raffaele Scientific Institute, Department of Cardiac Electrophysiology, Milan, Italy
| | - Paolo Della Bella
- IRCCS San Raffaele Scientific Institute, Department of Cardiac Electrophysiology, Milan, Italy
| | - Paolo Scarpellini
- IRCCS San Raffaele Scientific Institute, Department of Infectious Diseases, Milan, Italy
| | - Antonella Castagna
- San Raffaele Vita-Salute University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Department of Infectious Diseases, Milan, Italy
| | - Marco Ripa
- San Raffaele Vita-Salute University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Department of Infectious Diseases, Milan, Italy.
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19
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Burger H, Strauß M, Chung DU, Richter M, Ziegelhöffer T, Hakmi S, Reichenspurner H, Choi YH, Pecha S. Infection remediation after septic device extractions: analysis of three treatment strategies including a 1-year follow-up. Front Cardiovasc Med 2024; 10:1342886. [PMID: 38274307 PMCID: PMC10808596 DOI: 10.3389/fcvm.2023.1342886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 12/26/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction In CIED infections, all device material needs to be removed. But, especially in pacemaker-dependent patients it is often not possible to realize a device-free interval for infection remediation. In those patients, different treatment options are available, however the ideal solution needs still to be defined. Methods This retrospective analysis includes 190 patients undergoing CIED extractions due to infection. Three different treatment algorithms were analyzed: Group 1 included 89 patients with system removal only (System removal group). In Group 2, 28 patients received an epicardial electrode during extraction procedure (Epicardial lead group) while 78 patients in group 3 (contralateral reimplantation group) received implantation of a new system contralaterally during extraction procedure. We analyzed peri- and postoperative data as well as 1-year outcomes of the three groups. Results Patients in the system removal and epicardial lead groups were significantly older, had more comorbidities, and suffered more frequently from systemic infections than those in contralateral reimplantation group. Lead extraction procedures had comparable success rates: 95.5%, 96.4%, and 93.2% of complete lead removal in the System removal, Epicardial Lead, Contralateral re-implantation group respectively. Device reimplantation was performed in all patients in Epicardial lead and Contralateral reimplantation group, whereas only 49.4% in System removal group received device re-implantation. At 1-year follow-up, freedom from infection and absence of pocket irritation were comparable for all groups (94.7% Contralateral reimplantation group and Epicardial lead group, 100% System removal group). No procedure-related mortality was observed, whereas 1-year mortality was 3.4% in System removal group, 4.1% in Contralateral re-implantation group and 21.4% in Epicardial lead group (p < 0.001). Conclusion In patients with CIED infection, systems should be removed completely and reimplanted after infection remediation. In pacemaker-dependent patients, simultaneous contralateral CIED re-implantation or epicardial lead placement may be performed, depending on route, severity and location of infection.
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Affiliation(s)
- Heiko Burger
- Department of Cardiac Surgery, Kerckhoff-Klinik, Bad Nauheim, Germany
- CampusKerckhoff-Klinik, Justus-Liebig-University Gießen, Bad Nauheim, Germany
- Department of Angiology and Cardiology, CardioVascular Center, Frankfurt/Main, Germany
| | - Mona Strauß
- CampusKerckhoff-Klinik, Justus-Liebig-University Gießen, Bad Nauheim, Germany
| | - Da-Un Chung
- Department of Cardiology& Critical Care Medicine, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Manfred Richter
- Department of Cardiac Surgery, Kerckhoff-Klinik, Bad Nauheim, Germany
- CampusKerckhoff-Klinik, Justus-Liebig-University Gießen, Bad Nauheim, Germany
| | - Tibor Ziegelhöffer
- Department of Cardiac Surgery, Kerckhoff-Klinik, Bad Nauheim, Germany
- CampusKerckhoff-Klinik, Justus-Liebig-University Gießen, Bad Nauheim, Germany
| | - Samer Hakmi
- Department of Cardiovascular Surgery, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart and Vascular Center, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany
| | - Yeong-Hoon Choi
- Department of Cardiac Surgery, Kerckhoff-Klinik, Bad Nauheim, Germany
- CampusKerckhoff-Klinik, Justus-Liebig-University Gießen, Bad Nauheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site RhineMain, Frankfurt/Main, Germany
| | - Simon Pecha
- Department of Cardiovascular Surgery, University Heart and Vascular Center, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany
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20
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Pisani AR, Rubini D, Altini C, Ruta R, Gazzilli M, Sardaro A, Iuele F, Maggialetti N, Rubini G. The Role of the 18F-FDG PET/CT in the Management of Patients Suspected of Cardiac Implantable Electronic Devices' Infection. J Pers Med 2024; 14:65. [PMID: 38248766 PMCID: PMC10820973 DOI: 10.3390/jpm14010065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/11/2023] [Accepted: 12/26/2023] [Indexed: 01/23/2024] Open
Abstract
Background: Infection of Cardiac Implantable Electronic Devices (CIEDI) is a real public health problem. The main aim of this study was to determine the diagnostic performance of 18F-FDG PET/CT in the diagnosis of CIEDI. Methods: A total of 48 patients, who performed 18F-FDG PET/CT for the clinical suspicion of CIEDI were retrospectively analyzed; all patients were provided with a model with procedural recommendations before the exam. Sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy (DA) of 18F-FDG PET/CT were calculated; the reproducibility of qualitative analysis was assessed with Cohen's κ test. The semi-quantitative parameters (SUVmax, SQR and TBR) were evaluated in CIEDI+ and CIEDI- patients using the Student' t-test; ROC curves were elaborated to detect cut-off values. The trend of image quality with regards to procedural recommendation adherence was evaluated. Results: Se, Sp, PPV, NPV and DA were respectively 96.2%, 81.8%, 86.2%, 94.7% and 89.6%. The reproducibility of qualitative analysis was excellent (K = 0.89). Semiquantitative parameters resulted statistically different in CIEDI+ and CIEDI- patients. Cut-off values were SUVmax = 2.625, SQR = 3.766 and TBR = 1.29. Trend curves showed increasing image quality due to adherence to procedural recommendations. Conclusions:18F-FDG-PET/CT is a valid tool in the management of patients suspected of CIEDI and adherence to procedural recommendations improves its image quality.
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Affiliation(s)
- Antonio Rosario Pisani
- Interdisciplinary Department of Medicine, Section of Nuclear Medicine, University of Bari "Aldo Moro", Policlinic of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Dino Rubini
- Radiotherapy, Precision Medicine Department, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Corinna Altini
- Interdisciplinary Department of Medicine, Section of Nuclear Medicine, University of Bari "Aldo Moro", Policlinic of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Rossella Ruta
- Interdisciplinary Department of Medicine, Section of Nuclear Medicine, University of Bari "Aldo Moro", Policlinic of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | | | - Angela Sardaro
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari "Aldo Moro", Policlinic of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Francesca Iuele
- Interdisciplinary Department of Medicine, Section of Nuclear Medicine, University of Bari "Aldo Moro", Policlinic of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Nicola Maggialetti
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari "Aldo Moro", Policlinic of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Giuseppe Rubini
- Interdisciplinary Department of Medicine, Section of Nuclear Medicine, University of Bari "Aldo Moro", Policlinic of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
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21
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Babes EE, Bustea C, Ilias TI, Babes VV, Luca SA, Luca CT, Radu AF, Tarce AG, Bungau AF, Bustea C. Multimodality Imaging Diagnosis in Infective Endocarditis. Life (Basel) 2023; 14:54. [PMID: 38255669 PMCID: PMC10821102 DOI: 10.3390/life14010054] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/20/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024] Open
Abstract
Imaging is an important tool in the diagnosis and management of infective endocarditis (IE). Echocardiography is an essential examination, especially in native valve endocarditis (NVE), but its diagnostic accuracy is reduced in prosthetic valve endocarditis (PVE). The diagnostic ability is superior for transoesophageal echocardiography (TEE), but a negative test cannot exclude PVE. Both transthoracic echocardiography (TTE) and TEE can provide normal or inconclusive findings in up to 30% of cases, especially in patients with prosthetic devices. New advanced non-invasive imaging tests are increasingly used in the diagnosis of IE. Nuclear medicine imaging techniques have demonstrated their superiority over TEE for the diagnosis of PVE and cardiac implantable electronic device infective endocarditis (CIED-IE). Cardiac computed tomography angiography imaging is useful in PVE cases with inconclusive TTE and TEE investigations and for the evaluation of paravalvular complications. In the present review, imaging tools are described with their values and limitations for improving diagnosis in NVE, PVE and CIED-IE. Current knowledge about multimodality imaging approaches in IE and imaging methods to assess the local and distant complications of IE is also reviewed. Furthermore, a potential diagnostic work-up for different clinical scenarios is described. However, further studies are essential for refining diagnostic and management approaches in infective endocarditis, addressing limitations and optimizing advanced imaging techniques across different clinical scenarios.
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Affiliation(s)
- Elena Emilia Babes
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (E.E.B.); (A.-F.R.); (A.F.B.)
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (T.I.I.); (V.V.B.)
| | - Cristiana Bustea
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Tiberia Ioana Ilias
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (T.I.I.); (V.V.B.)
| | - Victor Vlad Babes
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (T.I.I.); (V.V.B.)
| | - Silvia-Ana Luca
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania
| | - Constantin Tudor Luca
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania
| | - Andrei-Flavius Radu
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (E.E.B.); (A.-F.R.); (A.F.B.)
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Alexandra Georgiana Tarce
- Medicine Program of Study, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania;
| | - Alexa Florina Bungau
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (E.E.B.); (A.-F.R.); (A.F.B.)
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Cristian Bustea
- Department of Surgery, Oradea County Emergency Clinical Hospital, 410169 Oradea, Romania;
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22
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Wu PJ, Chen HC, Fang YN, Chong SZ, Chen YL, Chen MC. Device-related infection and mortality in patients with chronic kidney disease receiving cardiac implantable electronic devices: a propensity score-matched cohort study. BMC Infect Dis 2023; 23:787. [PMID: 37957553 PMCID: PMC10644567 DOI: 10.1186/s12879-023-08773-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) was reported to be a risk factor of cardiac implantable electronic device (CIED) infection. The application of bundled skin antiseptic preparation before CIED implantation decreased the risk of CIED infection, even in patients undergoing complex procedures. However, the effect of bundled skin antiseptic preparation to prevent CIED infection in patients with CKD was not tested. METHODS Between July 2012 and December 2019, 1668 patients receiving CIEDs comprised this retrospective cohort study and were categorized into two groups by the diagnosis of CKD: group with CKD (n = 750, 45%) and group without CKD (n = 918, 55%). The primary outcome was clinical CIED infection, including major and minor infection, and the secondary outcomes were cardiovascular mortality and all-cause mortality. Propensity score matching (PSM) was applied to reduce selection bias between the study groups. RESULTS During a 4-year follow-up period, 30 patients (1.8%) had a CIED infection. After PSM, the incidence of CIED infection was similar between the patients with CKD and without CKD (1.0% vs. 1.8%). The incidences of cardiovascular mortality and all-cause mortality were higher in patients with CKD compared to patients without CKD (6.5% vs. 3.0%, P = 0.009; 22.8% vs. 11.8%, P < 0.001, respectively). CONCLUSION The incidence of clinical CIED infection in patients with CKD was as lower as in patients without CKD after applying the bundled skin antiseptic preparation strategy. The cumulative incidences of cardiovascular mortality and all-cause mortality were significantly higher in the matched CIED recipients with CKD compared to the matched cohort without CKD.
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Affiliation(s)
- Po-Jui Wu
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, 123 Ta Pei Road, Niao Sung District, Kaohsiung City, 83301, Taiwan
| | - Huang-Chung Chen
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, 123 Ta Pei Road, Niao Sung District, Kaohsiung City, 83301, Taiwan
| | - Yen-Nan Fang
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, 123 Ta Pei Road, Niao Sung District, Kaohsiung City, 83301, Taiwan
| | - Shaur-Zheng Chong
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, 123 Ta Pei Road, Niao Sung District, Kaohsiung City, 83301, Taiwan
| | - Yung-Lung Chen
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, 123 Ta Pei Road, Niao Sung District, Kaohsiung City, 83301, Taiwan
| | - Mien-Cheng Chen
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, 123 Ta Pei Road, Niao Sung District, Kaohsiung City, 83301, Taiwan.
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23
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Abstract
Septic pulmonary embolism (SPE) is a rare clinical entity that is distinct from the classic and more common non-septic thrombotic pulmonary embolism. SPE should be suspected in patients with a systemic acute inflammatory reaction or sepsis who develop signs and symptoms of pulmonary involvement. The diagnosis of SPE depends on the specific radiologic finding of multiple, peripheral, nodular, possibly cavitated lesions. SPE should prompt an immediate search for the primary source of infection; typically, right-sided infective endocarditis, cardiac implantable electronic devices, and septic thrombophlebitis as a complication of bone, skin, and soft tissue infection including Lemierre's syndrome, indwelling catheters, or direct inoculation via injection drug use. Invasive treatment of the infection source may be necessary; in thrombophlebitis, the efficacy and safety of anticoagulation remain undefined. Blood cultures may be negative, particularly among patients with recent antibiotic exposure, and broad-spectrum antimicrobial therapy should be considered. The in-hospital mortality of SPE ranges up to 20% in published case series. While trends in the incidence of SPE are unknown, the opioid epidemic, the growing use of cardiac implantable electronic devices worldwide, and the reported increase in cases of septic thrombophlebitis may be leading to an escalation in SPE cases. We provide a contemporary profile of SPE and propose a clinical management algorithm in patients with suspected or confirmed SPE.
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Affiliation(s)
- Luca Valerio
- Center for Thrombosis and Hemostasis, University Medical Center at the Johannes Gutenberg University, Mainz, Germany
- Department of Cardiology, University Medical Center at the Johannes Gutenberg University, Mainz, Germany
| | - Larry M Baddour
- Departments of Medicine and Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Division of Public Health, Infectious Diseases and Occupational Health, Rochester, Minnesota
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24
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Borov S, Baldauf B, Henke J, Pavaci H, Perani A, Zrenner B, Dietl J, Mehilli J, Lau EW, Vonthein R, Bonnemeier H. Use of a taurolidine containing antimicrobial wash to reduce cardiac implantable electronic device infection. Europace 2023; 25:euad306. [PMID: 37831737 PMCID: PMC10616572 DOI: 10.1093/europace/euad306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
AIMS TauroPace (Tauropharm, Bavaria Germany), a taurolidine solution for combating cardiac implantable electronic device (CIED) infection, was compared with a historical control of 3% hydrogen peroxide (H2O2) in a prospective observational study. METHODS AND RESULTS The device pocket was irrigated, and all hardware accessible within (leads, suture sleeves, pulse generator) was wiped with H2O2, TauroPace, or taurolidine in a galenic formulation during any invasive CIED procedure at the study centre. Only CIED procedures covered by TauroPace or H2O2 from 1 January 2017 to 28 February 2022 were included for analysis. Patients who underwent >1 procedure were censored for the last treatment group and reassigned at the next procedure. The primary endpoint was major CIED infection within 3 months. The secondary endpoints were CIED infection beyond 3 months, adverse events potentially related to the antimicrobial solutions, CIED system, procedure, and death, till the end of follow-up. TauroPace covered 654 procedures on 631 patients, and H2O2 covered 551 procedures on 532 patients. The TauroPace group had more patient risk factors for infection than the H2O2 group (P = 0.0058) but similar device and procedure-specific risk factors (P = 0.17). Cardiac implantable electronic device infection occurred in 0/654 (0%) of the TauroPace group and 6/551 (1.1%) of the H2O2 group (P = 0.0075). Death occurred in 23/654 (3.5%) of the TauroPace group and 14/551 (2.5%) of the H2O2 group (P = 0.33). Non-infection related adverse events were rarer in the TauroPace (3.8%) than the H2O2 (6.0%) group (P = 0.0802). CONCLUSION TauroPace is safe but more effective than H2O2 in reducing CIED infection. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05576194.
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Affiliation(s)
- Stefan Borov
- Department of Cardiology, Klinikum Freising, Alois-Steinecker-Straße 18, Freising 85354, Germany
- Medical Faculty, Christian-Albrechts University, Christian-Albrechts-Platz 4, Kiel 24118, Germany
| | - Benito Baldauf
- Medical Faculty, Christian-Albrechts University, Christian-Albrechts-Platz 4, Kiel 24118, Germany
- Institute of Life Science, Hochschule Bremerhaven, An der Karlstadt 8, Bremerhaven 27568, Germany
| | - Jana Henke
- Medical Faculty, Christian-Albrechts University, Christian-Albrechts-Platz 4, Kiel 24118, Germany
| | - Herribert Pavaci
- Krankenhaus Landshut Achdorf, Achdorfer Weg 3, Landshut 84036, Germany
| | - Arben Perani
- Krankenhaus Landshut Achdorf, Achdorfer Weg 3, Landshut 84036, Germany
| | - Bernhard Zrenner
- Krankenhaus Landshut Achdorf, Achdorfer Weg 3, Landshut 84036, Germany
| | - Josef Dietl
- Krankenhaus Landshut Achdorf, Achdorfer Weg 3, Landshut 84036, Germany
| | - Julinda Mehilli
- Krankenhaus Landshut Achdorf, Achdorfer Weg 3, Landshut 84036, Germany
| | - Ernest W Lau
- Department of Cardiology, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, UK
| | - Reinhard Vonthein
- Institut für Medizinische Biometrie und Statistik, Universität zu Lübeck, Ratzeburger Allee 160, Lübeck 23562, Germany
| | - Hendrik Bonnemeier
- Medical Faculty, Christian-Albrechts University, Christian-Albrechts-Platz 4, Kiel 24118, Germany
- Institute of Life Science, Hochschule Bremerhaven, An der Karlstadt 8, Bremerhaven 27568, Germany
- Department of Cardiology, Helios Klinikum Cuxhaven, Altenwalder Ch 10, Cuxhaven 27474, Germany
- Department of Cardiology, Helios Klinikum Wesermarsch, Mildred-Scheel-Straße 1, Nordenham 26954, Germany
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25
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Thompson GR, Jenks JD, Baddley JW, Lewis JS, Egger M, Schwartz IS, Boyer J, Patterson TF, Chen SCA, Pappas PG, Hoenigl M. Fungal Endocarditis: Pathophysiology, Epidemiology, Clinical Presentation, Diagnosis, and Management. Clin Microbiol Rev 2023; 36:e0001923. [PMID: 37439685 PMCID: PMC10512793 DOI: 10.1128/cmr.00019-23] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023] Open
Abstract
Fungal endocarditis accounts for 1% to 3% of all infective endocarditis cases, is associated with high morbidity and mortality (>70%), and presents numerous challenges during clinical care. Candida spp. are the most common causes of fungal endocarditis, implicated in over 50% of cases, followed by Aspergillus and Histoplasma spp. Important risk factors for fungal endocarditis include prosthetic valves, prior heart surgery, and injection drug use. The signs and symptoms of fungal endocarditis are nonspecific, and a high degree of clinical suspicion coupled with the judicious use of diagnostic tests is required for diagnosis. In addition to microbiological diagnostics (e.g., blood culture for Candida spp. or galactomannan testing and PCR for Aspergillus spp.), echocardiography remains critical for evaluation of potential infective endocarditis, although radionuclide imaging modalities such as 18F-fluorodeoxyglucose positron emission tomography/computed tomography are increasingly being used. A multimodal treatment approach is necessary: surgery is usually required and should be accompanied by long-term systemic antifungal therapy, such as echinocandin therapy for Candida endocarditis or voriconazole therapy for Aspergillus endocarditis.
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Affiliation(s)
- George R. Thompson
- Department of Internal Medicine, Division of Infectious Diseases, University of California-Davis Medical Center, Sacramento, California, USA
- Department of Medical Microbiology and Immunology, University of California-Davis, Davis, California, USA
| | - Jeffrey D. Jenks
- Durham County Department of Public Health, Durham, North Carolina, USA
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - John W. Baddley
- Department of Medicine, Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - James S. Lewis
- Department of Pharmacy, Oregon Health & Science University, Portland, Oregon, USA
| | - Matthias Egger
- Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Department of Medicine, Medical University of Graz, Graz, Austria
| | - Ilan S. Schwartz
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Johannes Boyer
- Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Department of Medicine, Medical University of Graz, Graz, Austria
| | - Thomas F. Patterson
- Department of Medicine, Division of Infectious Diseases, The University of Texas Health Science Center, San Antonio, Texas, USA
| | - Sharon C.-A. Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Sydney, New South Wales, Australia
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, The University of Sydney, Sydney, New South Wales, Australia
| | - Peter G. Pappas
- Department of Medicine Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Martin Hoenigl
- Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Department of Medicine, Medical University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
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26
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Khurana S, Das S, Frishman WH, Aronow WS, Frenkel D. Lead Extraction-Indications, Procedure, and Future Directions. Cardiol Rev 2023:00045415-990000000-00152. [PMID: 37729602 DOI: 10.1097/crd.0000000000000610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Cardiac implantable electronic device (CIED) implantation has steadily increased in the United States owing to increased life expectancy, better access to health care, and the adoption of updated guidelines. Transvenous lead extraction (TLE) is an invasive technique for the removal of CIED devices, and the most common indications include device infections, lead failures, and venous occlusion. Although in-hospital and procedure-related deaths for patients undergoing TLE are low, the long-term mortality remains high with 10-year survival reported close to 50% after TLE. This is likely demonstrative of the increased burden of comorbidities with aging. There are guidelines provided by various professional societies, including the Heart Rhythm Society, regarding indications for lead extraction and management of these patients. In this paper, we will review the indications for CIED extraction, procedural considerations, and management of these patients based upon the latest guidelines.
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Affiliation(s)
- Sumit Khurana
- From the Department of Internal medicine, MedStar Union Memorial hospital, Baltimore, MD
| | - Subrat Das
- Department of Cardiology, New York Medical College, Westchester Medical Center, Valhalla, NY
| | - William H Frishman
- Department of Medicine, Westchester Medical Center and New York Medical College, NY
| | - Wilbert S Aronow
- Department of Cardiology, New York Medical College, Westchester Medical Center, Valhalla, NY
| | - Daniel Frenkel
- Department of Cardiology, New York Medical College, Westchester Medical Center, Valhalla, NY
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27
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Sandoe JAT, Ahmed F, Arumugam P, Guleri A, Horner C, Howard P, Perry J, Prendergast BD, Schwiebert R, Steeds RP, Watkin R, Wendler O, Chambers JB. Expert consensus recommendations for the provision of infective endocarditis services: updated guidance from the Joint British Societies. Heart 2023; 109:e2. [PMID: 36898706 PMCID: PMC10423555 DOI: 10.1136/heartjnl-2022-321791] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
Infective endocarditis (IE) remains a difficult condition to diagnose and treat and is an infection of high consequence for patients, causing long hospital stays, life-changing complications and high mortality. A new multidisciplinary, multiprofessional, British Society for Antimicrobial Chemotherapy (BSAC)-ledWorking Party was convened to undertake a focused systematical review of the literature and to update the previous BSAC guidelines relating delivery of services for patients with IE. A scoping exercise identified new questions concerning optimal delivery of care, and the systematic review identified 16 231 papers of which 20 met the inclusion criteria. Recommendations relating to endocarditis teams, infrastructure and support, endocarditis referral processes, patient follow-up and patient information, and governance are made as well as research recommendations. This is a report of a joint Working Party of the BSAC, British Cardiovascular Society, British Heart Valve Society, British Society of Echocardiography, Society of Cardiothoracic Surgeons of Great Britain and Ireland, British Congenital Cardiac Association and British Infection Association.
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Affiliation(s)
- Jonathan A T Sandoe
- Microbiology department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Fozia Ahmed
- Manchester Heart Centre, Manchester University NHS Foundation Trust, Manchester, UK
- The University of Manchester, Manchester, UK
| | - Parthiban Arumugam
- Manchester Heart Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Achyut Guleri
- Microbiology department, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - Carolyne Horner
- Formerly British Society of Antimicrobial Chemotherapy, Birmingham, UK
| | - Philip Howard
- NHS England North East & Yorkshire, Leeds, UK
- University of Leeds, Leeds, UK
| | - John Perry
- Microbiology department, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Bernard D Prendergast
- Cardiology department, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Cleveland Clinic, London, UK
| | - Ralph Schwiebert
- Microbiology department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- School of Medicine, University of Leeds, Leeds, UK
| | - Richard Paul Steeds
- Cardiology department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Richard Watkin
- Cardiology department, University Hospitals Birmingham NHS Foundation Trust, Sutton Coldfield, UK
| | - Olaf Wendler
- Cardiothoracic Surgery, King's College Hospital, King's Health Partners, London, UK
| | - John B Chambers
- Cardiology department, Guy's and St Thomas' NHS Foundation Trust, London, UK
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28
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Shawon MSR, Sotade OT, Hill M, Strachan L, Challis G, Ooi SY, Jorm LR. Real-world evidence on the association between cardiac implantable electronic device infection and all-cause mortality. Europace 2023; 25:euad274. [PMID: 37703326 PMCID: PMC10521903 DOI: 10.1093/europace/euad274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/04/2023] [Indexed: 09/15/2023] Open
Abstract
AIMS An infection following cardiac implantable electronic device (CIED) procedure is a serious complication, but its association with all-cause mortality is inconsistent across observational studies. To quantify the association between CIED infection and all-cause mortality in a large, contemporary cohort from New South Wales, Australia. METHODS AND RESULTS This retrospective cohort study used linked hospital and mortality data and included all patients aged >18 years who underwent a CIED procedure between July 2017 and September 2022. Cardiac implantable electronic device infection was defined by the presence of relevant diagnosis codes. Cox regression to estimate adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) for the association of CIED infection with mortality, at 1-year, and at the end of follow-up, with CIED infection included as a time-dependent variable, and other potential risk factors for mortality included as fixed covariates. We followed 37,750 patients with CIED procedures {36% female, mean age [standard deviation (SD)] 75.8 [12.7] years}, and 487 (1.3%) CIED infections were identified. We observed 5771 (15.3%) deaths during an average follow-up of 25.2 (SD 16.8) months. Compared with no infection group, patients with CIED infection had a higher Kaplan-Meier mortality rate (19.4 vs. 6.8%) and adjusted hazard of mortality (aHR 2.73, 95% CI 2.10-3.54) at 12 months post-procedure. These differences were attenuated but still remained significant at the end of follow-up (aHR 1.83, 95% CI 1.52-2.19). CONCLUSION In a complete, state-wide cohort of CIED patients, infection was associated with higher risks of both short-term and long-term mortality.
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Affiliation(s)
- Md Shajedur Rahman Shawon
- Centre for Big Data Research in Health, University of New South Wales, Level 2, AGSM Building (G27), Sydney, NSW 2052, Australia
| | - Oluwadamisola Temilade Sotade
- Centre for Big Data Research in Health, University of New South Wales, Level 2, AGSM Building (G27), Sydney, NSW 2052, Australia
| | - Michelle Hill
- Medtronic Australasia Pty Ltd., Sydney, NSW, Australia
| | | | | | - Sze-Yuan Ooi
- Department of Cardiology, Prince of Wales Hospital, Sydney, Australia
- UNSW Medicine, UNSW Sydney, NSW, Australia
| | - Louisa R Jorm
- Centre for Big Data Research in Health, University of New South Wales, Level 2, AGSM Building (G27), Sydney, NSW 2052, Australia
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29
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Donal E, Tribouilloy C, Sadeghpour A, Laroche C, Tude Rodrigues AC, Pereira Nunes MDC, Kang DH, Hernadez-Meneses M, Kobalava Z, De Bonis M, Dworakowski R, Ivanovic B, Holicka M, Kitai T, Cruz I, Huttin O, Colonna P, Lancellotti P, Habib G. Cardiac device-related infective endocarditis need for lead extraction whatever the device according to the ESC EORP EURO-ENDO registry. EUROPEAN HEART JOURNAL OPEN 2023; 3:oead064. [PMID: 37465258 PMCID: PMC10351571 DOI: 10.1093/ehjopen/oead064] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 02/26/2023] [Accepted: 03/20/2023] [Indexed: 07/20/2023]
Abstract
Aims Cardiac device-related infective endocarditis (CDRIE) is a severe complication of cardiac device (CD) implantation and is usually treated by antibiotic therapy and percutaneous device extraction. Few studies report the management and prognosis of CDRIE in real life. In particular, the rate of device extraction in clinical practice and the management of patients with left heart infective endocarditis (LHIE) and an apparently non-infected CD (LHIE+CDRIE-) are not well described. Methods and results We sought to study in EURO-ENDO, the characteristics, prognosis, and management of 483 patients with a CD included in the European Society of Cardiology EurObservational Research Programme EURO-ENDO registry. Three populations were compared: 280 isolated CDRIE (66.7 ± 14.3 years), 157 patients with LHIE and an apparently non-infected CD (LHIE+CDRIE-) (71.1 ± 13.6), and 46 patients with both LHIE and CDRIE (LHIE+CDRIE+) (70.2 ± 10.1). Echocardiography was not always transoesophageal echography (TOE); it was transthoracic echography (TTE) for isolated CDRIE in 88.4% (TOE = 67.6%), for LHIE+CDRIE- TTE = 93.0% (TOE = 58.6%), and for CDRIE+LHIE+ TTE = 87.0% (TOE = 63.0%). Nuclear imaging was performed in 135 patients (positive for 75.6%). In-hospital mortality was lower in isolated CDRIE 13.2% vs. 22.3% and 30.4% for LHIE+CDRIE- and LHIE+CDRIE+ (P = 0004). Device extraction was performed in 62.1% patients with isolated CDRIE, 10.2% of LHIE+CDRIE- patients, and 45.7% of CDRIE+LHIE+ patients. Device extraction was associated with a better prognosis [hazard ratio 0.59 (0.40-0.87), P = 0.0068] even in the LHIE+CDRIE- group (P = 0.047). Conclusion Prognosis of endocarditis in patients with a CD remains poor, particularly in the presence of an associated LHIE. Although recommended by guidelines, device extraction is not always performed. Device removal was associated with better prognosis, even in the LHIE+CDRIE- group.
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Affiliation(s)
- Erwan Donal
- Corresponding author. Tel: +33299282525, Fax: +33299282510,
| | | | - Anita Sadeghpour
- Echocardiography Research Centre, Rajaie Cardiovascular Medical and Research Centre, Iran University of Medical Sciences, Tehran, Iran
| | - Cécile Laroche
- European Society of Cardiology, EORP, Sophia-Antipolis, France
| | - Ana Clara Tude Rodrigues
- servico de Echocardiografia—InRad-HC—Faculdade de Medicina, Universidade de Sao Paulo, SP, Brazil
| | - Maria do Carmo Pereira Nunes
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Duk-Hyun Kang
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap-dong, Songpa-gu, Seoul 138-736, Korea
| | - Marta Hernadez-Meneses
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | - Michele De Bonis
- Cardiac Surgery, Innovation and Research, ‘Vita-Salute’ San Raffaele University Hospital, Milan 20132, Italy
| | - Rafal Dworakowski
- Department of Cardiology, Kings College Hospital and King's College London, Denmark Hill, London SE5 9RS, UK
| | | | - Maria Holicka
- Department of Cardiology, University Hospital Brno, Jihlavska 20, Brno 62500, Czech Republic
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Ines Cruz
- Departamento de Cardiologia, Hospital Garcia de Orta, Almada, Portugal
| | - Olivier Huttin
- F-CRIN INI-CRCT Cardiovascular and Renal Clinical Trialists Network, INSERM 1116, CHRU de Nancy, Nancy, France
| | - Paolo Colonna
- Department of Cardiology, Polyclinic of Bari—Hospital, Bari 70124, Italy
| | - Patrizio Lancellotti
- Department of Cardiology, Heart Valve Clinic, GIGA Cardiovascular Sciences, CHU Sart Tilman, University of Liege Hospital, Liege, Belgium
- Department of Cardiology, Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
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30
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Milman A, Wieder-Finesod A, Zahavi G, Meitus A, Kariv S, Shafir Y, Beinart R, Rahav G, Nof E. Complicated Pocket Infection in Patients Undergoing Lead Extraction: Characteristics and Outcomes. J Clin Med 2023; 12:4397. [PMID: 37445433 DOI: 10.3390/jcm12134397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/18/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
Cardiac implantable electronic device (CIED) infection can present with pocket or systemic manifestations, both necessitating complete device removal and pathogen-directed antimicrobial therapy. Here, we aim to characterize those presenting with both pocket and systemic infection. A retrospective analysis of CIED extraction procedures included 300 patients divided into isolated pocket (n = 104, 34.7%), complicated pocket (n = 54, 18%), and systemic infection (n = 142, 47.3%) groups. The systemic and complicated pocket groups frequently presented with leukocytosis and fever > 37.8, as opposed to the isolated pocket group. Staphylococcus aureus was the most common pathogen in the systemic and complicated pocket groups (43.7% and 31.5%, respectively), while Coagulase-negative staphylococci (CONS) predominated (31.7%) in the isolated pocket group (10.6%, p < 0.001). No differences were observed in procedural success or complications rates. Kaplan-Meier survival analysis found that at three years of follow-up, the rate of all-cause mortality was significantly higher among patients with systemic infection compared to both pocket groups (p < 0.001), with the curves diverging at thirty days. In this study, we characterize a new entity of complicated pocket infection. Despite the systemic pattern of infection, their prognosis is similar to isolated pocket infection. We suggest that this special category be presented separately in future publications of CIED infections.
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Affiliation(s)
- Anat Milman
- Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 5262000, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Anat Wieder-Finesod
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- The Infectious Diseases Unit, Sheba Medical Center, Tel-Hashomer, Ramat Gan 5262000, Israel
| | - Guy Zahavi
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Anesthesiology and Intensive Care, The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 5262000, Israel
| | - Amit Meitus
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Saar Kariv
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Yuval Shafir
- Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 5262000, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Roy Beinart
- Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 5262000, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Galia Rahav
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- The Infectious Diseases Unit, Sheba Medical Center, Tel-Hashomer, Ramat Gan 5262000, Israel
| | - Eyal Nof
- Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 5262000, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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31
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Arabia G, Mitacchione G, Cersosimo A, Calvi E, Salghetti F, Bontempi L, Giacopelli D, Cerini M, Curnis A. Long-term outcomes following transvenous lead extraction: Data from a tertiary referral center. Int J Cardiol 2023; 378:32-38. [PMID: 36841289 DOI: 10.1016/j.ijcard.2023.02.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/16/2023] [Accepted: 02/22/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND Transvenous lead extraction (TLE) has shown a safe and efficacy profile in the intraoperative and short-term setting; however, data on long-term outcomes are limited. OBJECTIVE The purpose of this study was to assess long-term outcomes and prognostic factors in patients who underwent TLE. METHODS Consecutive patients with cardiac implantable electronic device (CIED) who underwent TLE between 2014 and 2016 were retrospectively studied. The primary outcome was the composite endpoint of death and repeated TLE stratified by infective/non-infective indication. Individual components of the primary outcome were also evaluated. RESULTS One hundred ninety-one patients were included in the analysis, 50% extracted for CIED-related infection. Complete procedural success was achieved in 189 patients (99%) with no major acute complications. After a median of 6.5 years, infection indication was associated with significantly lower event-free survival (67% vs. 83% non-infection group, adjusted hazard ratio [aHR] 1.97, 95% confidence interval [CI] 1.02-3.81, p = 0.04). All-cause mortality rate was higher in the TLE infection group (30% vs. 10%, p < 0.01). The rate of repeated TLE did not differ between groups (4% vs. 7%, p = 0.62). Among patients who had TLE for infection, the presence of vegetation (aHR 2.56; 95%CI 1.17-5.63, p = 0.02) and positive blood cultures (aHR 2.64; 95%CI 1.04-6.70, p = 0.04) were independently associated with the primary outcome. CONCLUSION Patients who underwent TLE for CIED-related infection exhibit a high mortality risk during long-term follow-up. Vegetation and positive blood cultures in patients with CIED-related infection are associated with a worse prognosis regardless of successful and uncomplicated TLE.
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Affiliation(s)
- Gianmarco Arabia
- Cardiology Department, Spedali Civili Hospital, University of Brescia, Italy.
| | | | - Angelica Cersosimo
- Cardiology Department, Spedali Civili Hospital, University of Brescia, Italy
| | - Emiliano Calvi
- Cardiology Department, Spedali Civili Hospital, University of Brescia, Italy
| | - Francesca Salghetti
- Cardiology Department, Spedali Civili Hospital, University of Brescia, Italy
| | - Luca Bontempi
- Cardiology Department, Spedali Civili Hospital, University of Brescia, Italy
| | - Daniele Giacopelli
- Clinical Unit, Biotronik Italia, Cologno Monzese (MI), Italy; Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Italy
| | - Manuel Cerini
- Cardiology Department, Spedali Civili Hospital, University of Brescia, Italy
| | - Antonio Curnis
- Cardiology Department, Spedali Civili Hospital, University of Brescia, Italy
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Lakkireddy DR, Segar DS, Sood A, Wu M, Rao A, Sohail MR, Pokorney SD, Blomström-Lundqvist C, Piccini JP, Granger CB. Early Lead Extraction for Infected Implanted Cardiac Electronic Devices: JACC Review Topic of the Week. J Am Coll Cardiol 2023; 81:1283-1295. [PMID: 36990548 DOI: 10.1016/j.jacc.2023.01.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/04/2023] [Accepted: 01/18/2023] [Indexed: 03/31/2023]
Abstract
Infection remains a serious complication associated with the cardiac implantable electronic devices (CIEDs), leading to substantial clinical and economic burden globally. This review assesses the burden of cardiac implantable electronic device infection (CIED-I), evidence for treatment recommendations, barriers to early diagnosis and appropriate therapy, and potential solutions. Multiple clinical practice guidelines recommended complete system and lead removal for CIED-I when appropriate. CIED extraction for infection has been consistently reported with high success, low complication, and very low mortality rates. Complete and early extraction was associated with significantly better clinical and economic outcome compared with no or late extraction. However, significant gaps in knowledge and poor recommendation compliance have been reported. Barriers to optimal management may include diagnostic delay, knowledge gaps, and limited access to expertise. A multipronged approach, including education of all stakeholders, a CIED-I alert system, and improving access to experts, could help bring paradigm shift in the treatment of this serious condition.
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Affiliation(s)
| | - Douglas S Segar
- Ascension Heart Center of Indiana, Indianapolis, Indiana, USA
| | - Ami Sood
- Philips Image Guided Therapy Corporation, Colorado Springs, Colorado, USA
| | | | - Archana Rao
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - M Rizwan Sohail
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Sean D Pokorney
- Duke University Medical Center and Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Carina Blomström-Lundqvist
- Department of Cardiology, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Medical Science, Uppsala University, Uppsala, Sweden
| | - Jonathan P Piccini
- Duke University Medical Center and Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Christopher B Granger
- Duke University Medical Center and Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
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Jain A, Subramani S, Gebhardt B, Hauser J, Bailey C, Ramakrishna H. Infective Endocarditis-Update for the Perioperative Clinician. J Cardiothorac Vasc Anesth 2023; 37:637-649. [PMID: 36725476 DOI: 10.1053/j.jvca.2022.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 12/28/2022] [Indexed: 01/07/2023]
Abstract
Infective endocarditis is a common pathology routinely encountered by perioperative physicians. There has been a need for a comprehensive review of this important topic. In this expert review, the authors discuss in detail the incidence, etiology, definition, microbiology, and trends of infective endocarditis. The authors discuss the clinical and imaging criteria for diagnosing infective endocarditis and the perioperative considerations for the same. Other imaging modalities to evaluate infective endocarditis also are discussed. Furthermore, the authors describe in detail the clinical risk scores that are used for determining clinical prognostic criteria and how they are tied to the current societal guidelines. Knowledge about native and prosthetic valve endocarditis, with emphasis on the timing of surgical intervention-focused surgical approaches and analysis of current outcomes, are critical to managing such patients, especially high-risk patients like those with heart failure, patients with intravenous drug abuse, and with internal pacemakers and defibrillators in situ. And lastly, with the advancement of percutaneous transcatheter valves becoming a norm for the management of various valvular pathologies, the authors discuss an in-depth review of transcatheter valve endocarditis with a focus on its incidence, the timing of surgical interventions, outcome data, and management of high-risk patients.
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Affiliation(s)
- Ankit Jain
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia & Augusta University, Augusta, GA
| | - Sudhakar Subramani
- Department of Anesthesiology and Perioperative Medicine, University of Iowa, Iowa City, IA
| | - Brian Gebhardt
- Department of Anesthesiology and Perioperative Medicine, University of Massachusetts Memorial Medical Center, MA
| | - Joshua Hauser
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Caryl Bailey
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia & Augusta University, Augusta, GA
| | - Harish Ramakrishna
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
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Hernández-Meneses M, Perissinotti A, Vidal B, Tolosana JM, Miró JM. Diagnóstico clínico y por imagen de las infecciones de los dispositivos de estimulación cardiaca. CIRUGIA CARDIOVASCULAR 2023. [DOI: 10.1016/j.circv.2022.12.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
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35
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Kalot MA, Bahuva R, Pandey R, Farooq W, Mir A, Khan A, Kerling D, Aftab H, Kovacs A, Gupta S, Smith M, Tian L, Amuthan R, Sharma UC. Risk factors associated with higher mortality in patients with cardiac implantable electronic device infection. J Cardiovasc Electrophysiol 2023; 34:738-747. [PMID: 36640427 PMCID: PMC10006317 DOI: 10.1111/jce.15817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/02/2023] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Cardiac Implantable Electronic Devices (CIEDs) are widely used for the management of advanced heart failure and ventricular arrhythmias. CIED-Infection (CIED-I) has very high mortality, especially in the subsets of patients with limited health-care access and delayed presentation. The purpose of this study is to identify the risk-predictors mortality in subjects with CIED-I. METHODS We performed a retrospective cohort study of a regional database in patients presenting with CIED infections to tertiary care medical centers across Western New York, USA from 2012 to 2020. The clinical outcomes included recurrent device infection (any admission for CIED-I after the first hospitalization for device infection), septic complications (pulmonary embolism, respiratory failure, septic shock, decompensated HF, acute kidney injury) and mortality outcomes (death during hospitalization, within 30 days from CIED-I, and within 1 year from CIED-I). We studied associations between categorical variables and hard outcomes using χ2 tests and used one-way analysis of variance to measure between-groups differences. RESULTS We identified 296 patients with CIED-I, among which 218 (74%) were male, 237 (80%) were white and the mean age at the time of infection was 69.2 ± 13.7 years. One-third of the patients were referred from the regional facilities. Staphylococcus aureus was responsible for most infections, followed by Enterococcus fecalis. On multivariate analysis, the covariates associated with significantly increased mortality risk included referral from regional facility (OR: 2.0;1.0-4.0), hypertension (Odds ratio, OR: 3.2;1.3-8.8), right ventricular dysfunction (OR: 2.6;1.2-5.1), end-stage renal disease (OR: 2.6;1.1-6.2), immunosuppression (OR: 11.4;2.5-53.3), and septic shock as a complication of CIED-I (OR: 3.9;1.3-10.8). CONCLUSION Hypertension, right ventricular dysfunction, immunosuppression, and end-stage renal disease are associated with higher mortality after CIED-I. Disproportionately higher mortality was also noted in subjects referred from the regional facilities. This underscores the importance of early clinical risk-assessment, and the need for a robust referral infrastructure to improve patient outcomes.
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Affiliation(s)
- Mohamad A Kalot
- Department of Medicine, Clinical & Translational Research Center, Buffalo, New York, USA
| | - Ronak Bahuva
- Department of Medicine, Clinical & Translational Research Center, Buffalo, New York, USA
| | - Rohan Pandey
- Department of Medicine, Clinical & Translational Research Center, Buffalo, New York, USA
| | - Waseem Farooq
- Department of Medicine, Clinical & Translational Research Center, Buffalo, New York, USA
| | - Ali Mir
- Department of Medicine, Clinical & Translational Research Center, Buffalo, New York, USA
| | - Aalia Khan
- Department of Medicine, Clinical & Translational Research Center, Buffalo, New York, USA
| | - David Kerling
- Department of Medicine, Clinical & Translational Research Center, Buffalo, New York, USA
| | - Hamza Aftab
- Department of Medicine, Clinical & Translational Research Center, Buffalo, New York, USA
| | - Alexander Kovacs
- Department of Medicine, Clinical & Translational Research Center, Buffalo, New York, USA
| | - Shilpi Gupta
- Department of Medicine, Clinical & Translational Research Center, Buffalo, New York, USA
| | - Morgan Smith
- Department of Medicine, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, New York, USA
| | - Lili Tian
- Department of Biostatistics, University at Buffalo, Buffalo, New York, USA
| | - Ram Amuthan
- Department of Medicine, Division of Cardiology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Umesh C Sharma
- Department of Medicine, Clinical & Translational Research Center, Buffalo, New York, USA
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36
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Just IA, Barthel F, Moter A, Kikhney J, Friedrich A, Wloch A, Falk V, Starck C, Schoenrath F. Fluorescence in situ hybridization and polymerase chain reaction to detect infections of cardiac implantable electronic devices. Europace 2023; 25:578-585. [PMID: 36477494 PMCID: PMC9935028 DOI: 10.1093/europace/euac228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 10/23/2022] [Indexed: 12/12/2022] Open
Abstract
AIMS In patients with infections of cardiac implantable electronic devices (CIEDs), the identification of causative pathogens is complicated by biofilm formations and previous antibiotic therapy. In this work, the impact of an additional fluorescence in situ hybridization (FISH), in combination with polymerase chain reaction and sequencing (FISHseq) was investigated. METHODS AND RESULTS In 36 patients with CIED infections, FISHseq of explanted devices was performed and compared with standard microbiological cultivation of preoperative and intraoperative samples. The mean age was 61.9 (±16.2) years; 25 (69.4%) were males. Most patients (62.9%) had heart failure with reduced ejection fraction. Infections occurred as endoplastits (n = 26), isolated local generator pocket infection (n = 8), or both (n = 2); CIED included cardiac resynchronization therapy defibrillator (n = 17), implantable cardioverter defibrillator (n = 11), and pacemaker (n = 8) devices. The overall positive FISHseq detection rate was 97%. Intraoperatively, pathogens were isolated in 42 vs. 53% in standard cultivation vs. FISHseq, respectively. In 16 of 17 FISHseq-negative patients, the nucleic acid strain DAPI (4',6-diamidino-2-phenylindole) indicated inactive microorganisms, which were partially organized in biofilms (n = 4) or microcolonies (n = 2). In 13 patients in whom no pathogen was identified preoperatively, standard cultivation and FISHseq identified pathogens in 3 (23%) vs. 8 (62%), respectively. For the confirmation of preoperatively known bacteria, a combined approach was most efficient. CONCLUSION Fluorescence in situ hybridization sequencing is a valuable tool to detect causative microorganisms in CIED infections. The combination of FISHseq with preoperative cultivation showed the highest efficacy in detecting pathogens. Additional cultivation of intraoperative tissue samples or swabs yielded more confirmation of pathogens known from preoperative culture.
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Affiliation(s)
- Isabell Anna Just
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Frank Barthel
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Annette Moter
- Biofilmcenter, Institute of Microbiology, Infectious Diseases and Immunology, Charité—University Medical Center Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
- MoKi Analytics GmbH, Hindenburgdamm 30, 12203 Berlin, Germany
- Moter Diagnostics Practice, Marienplatz 9, 12207 Berlin, Germany
| | - Judith Kikhney
- Biofilmcenter, Institute of Microbiology, Infectious Diseases and Immunology, Charité—University Medical Center Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
- MoKi Analytics GmbH, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Aljona Friedrich
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Alexa Wloch
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Cardiothoracic Surgery, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Christoph Starck
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Felix Schoenrath
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Cardiothoracic Surgery, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Martín-Gutiérrez G, Lepe JA. Etiología y diagnóstico microbiológico de las infecciones de dispositivos de estimulación cardiaca. CIRUGIA CARDIOVASCULAR 2023. [DOI: 10.1016/j.circv.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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38
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Thornhill MH, Crum A, Campbell R, Stone T, Lee EC, Bradburn M, Fibisan V, Dayer M, Prendergast BD, Lockhart P, Baddour L, Nicoll J. Temporal association between invasive procedures and infective endocarditis. Heart 2023; 109:223-231. [PMID: 36137742 PMCID: PMC9872236 DOI: 10.1136/heartjnl-2022-321519] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/02/2022] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE Antibiotic prophylaxis has been recommended for patients at increased risk of infective endocarditis (IE) undergoing specific invasive procedures (IPs) despite a lack of data supporting its use. Therefore, antibiotic prophylaxis recommendations ceased in the mid-2000s for all but those at high IE risk undergoing invasive dental procedures. We aimed to quantify any association between IPs and IE. METHODS All 14 731 IE hospital admissions in England between April 2010 and March 2016 were identified from national admissions data, and medical records were searched for IP performed during the 15-month period before IE admission. We compared the incidence of IP during the 3 months immediately before IE admission (case period) with the incidence during the preceding 12 months (control period) to determine whether the odds of developing IE were increased in the 3 months after certain IP. RESULTS The odds of IE were increased following permanent pacemaker and defibrillator implantation (OR 1.54, 95% CI 1.27 to 1.85, p<0.001), extractions/surgical tooth removal (OR 2.14, 95% CI 1.22 to 3.76, p=0.047), upper (OR 1.58, 95% CI 1.34 to 1.85, p<0.001) and lower gastrointestinal endoscopy (OR 1.66, 95% CI 1.35 to 2.04, p<0.001) and bone marrow biopsy (OR 1.76, 95% CI 1.16 to 2.69, p=0.039). Using an alternative analysis, bronchoscopy (OR 1.33, 95% CI 1.06 to 1.68, p=0.049) and blood transfusions/red cell/plasma exchange (OR 1.2, 95% CI 1.07 to 1.35, p=0.012) were also associated with IE. CONCLUSIONS This study identifies a significant association between specific IPs (permanent pacemaker and defibrillator implantation, dental extraction, gastrointestinal endoscopy and bronchoscopy) and subsequent IE that warrants re-evaluation of current antibiotic prophylaxis recommendations to prevent IE in high IE risk individuals.
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Affiliation(s)
- Martin H Thornhill
- Department of Oral & Maxillofacial Medicine, Surgery and Pathology, The University of Sheffield School of Clinical Dentistry, Sheffield, UK .,Department of Oral Medicine/Oral & Maxillofacial Surgery, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Annabel Crum
- The University of Sheffield School of Health and Related Research, Sheffield, UK
| | - Richard Campbell
- The University of Sheffield School of Health and Related Research, Sheffield, UK
| | - Tony Stone
- The University of Sheffield School of Health and Related Research, Sheffield, UK
| | - Ellen C Lee
- The University of Sheffield School of Health and Related Research, Sheffield, UK
| | - Mike Bradburn
- CTRU, University of Sheffield School of Health and Related Research, Sheffield, UK
| | - Veronica Fibisan
- The University of Sheffield School of Health and Related Research, Sheffield, UK
| | - Mark Dayer
- Department of Cardiology, Somerset Foundation Trust, Taunton, Somerset, UK
| | | | - Peter Lockhart
- Department of Oral Medicine/Oral & Maxillofacial Surgery, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Larry Baddour
- Departments of Medicine and Cardiovascular Disease, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Jon Nicoll
- The University of Sheffield School of Health and Related Research, Sheffield, UK
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Ponta G, Ranzenigo M, Marzi A, Oltolini C, Tassan Din C, Spagnuolo V, Mazzone P, Carletti S, Mancini N, Uberti-Foppa C, Della Bella P, Scarpellini P, Castagna A, Ripa M. Cardiac implantable electronic device infections: impact of initiation of antimicrobial treatment before or after device removal on microbiological yield. Clin Microbiol Infect 2023; 29:260-262. [PMID: 36336235 DOI: 10.1016/j.cmi.2022.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Giacomo Ponta
- San Raffaele Vita-Salute University, Milan, Italy; Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Department of Infectious Diseases, Milan, Italy
| | - Martina Ranzenigo
- San Raffaele Vita-Salute University, Milan, Italy; Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Department of Infectious Diseases, Milan, Italy
| | - Alessandra Marzi
- Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Department of Cardiac Electrophysiology, Milan, Italy
| | - Chiara Oltolini
- Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Department of Infectious Diseases, Milan, Italy
| | - Chiara Tassan Din
- Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Department of Infectious Diseases, Milan, Italy
| | - Vincenzo Spagnuolo
- San Raffaele Vita-Salute University, Milan, Italy; Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Department of Infectious Diseases, Milan, Italy
| | - Patrizio Mazzone
- Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Department of Cardiac Electrophysiology, Milan, Italy
| | - Silvia Carletti
- Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Department of Microbiology and Virology, Milan, Italy
| | - Nicasio Mancini
- San Raffaele Vita-Salute University, Milan, Italy; Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Department of Microbiology and Virology, Milan, Italy
| | - Caterina Uberti-Foppa
- San Raffaele Vita-Salute University, Milan, Italy; Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Department of Infectious Diseases, Milan, Italy
| | - Paolo Della Bella
- Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Department of Cardiac Electrophysiology, Milan, Italy
| | - Paolo Scarpellini
- Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Department of Infectious Diseases, Milan, Italy
| | - Antonella Castagna
- San Raffaele Vita-Salute University, Milan, Italy; Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Department of Infectious Diseases, Milan, Italy
| | - Marco Ripa
- San Raffaele Vita-Salute University, Milan, Italy; Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Department of Infectious Diseases, Milan, Italy.
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Topaz M, Chorin E, Schwartz AL, Hochstadt A, Shotan A, Ashkenazi I, Kazatsker M, Carmel NN, Topaz G, Oron Y, Margolis G, Nof E, Beinart R, Glikson M, Mazo A, Milman A, Dekel M, Banai S, Rosso R, Viskin S. Regional Antibiotic Delivery for Implanted Cardiovascular Electronic Device Infections. J Am Coll Cardiol 2023; 81:119-133. [PMID: 36631206 DOI: 10.1016/j.jacc.2022.10.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/19/2022] [Accepted: 10/14/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Present guidelines endorse complete removal of cardiovascular implantable electronic devices (pacemakers/defibrillators), including extraction of all intracardiac electrodes, not only for systemic infections, but also for localized pocket infections. OBJECTIVES The authors evaluated the efficacy of delivering continuous, in situ-targeted, ultrahigh concentration of antibiotics (CITA) into the infected subcutaneous device pocket, obviating the need for device/lead extraction. METHODS The CITA group consisted of 80 patients with pocket infection who were treated with CITA during 2007-2021. Of them, 9 patients declined lead extraction because of prohibitive operative risk, and 6 patients had questionable indications for extraction. The remaining 65 patients with pocket infection, who were eligible for extraction, but opted for CITA treatment, were compared with 81 patients with pocket infection and similar characteristics who underwent device/lead extraction as primary therapy. RESULTS A total of 80 patients with pocket infection were treated with CITA during 2007-2021. CITA was curative in 85% (n = 68 of 80) of patients, who remained free of infection (median follow-up 3 years [IQR: 1.0-6.8 years]). In the case-control study of CITA vs device/lead extraction, cure rates were higher after device/lead extraction than after CITA (96.2% [n = 78 of 81] vs 84.6% [n = 55 of 65]; P = 0.027). However, rates of serious complications were also higher after extraction (n = 12 [14.8%] vs n = 1 [1.5%]; P = 0.005). All-cause 1-month and 1-year mortality were similar for CITA and device/lead extraction (0.0% vs 3.7%; P = 0.25 and 12.3% vs 13.6%; P = 1.00, respectively). Extraction was avoided in 90.8% (n = 59 of 65) of extraction-eligible patients treated with CITA. CONCLUSIONS CITA is a safe and effective alternative for patients with pocket infection who are unsuitable or unwilling to undergo extraction. (Salvage of Infected Cardiovascular Implantable Electronic Devices [CIED] by Localized High-Dose Antibiotics; NCT01770067).
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Affiliation(s)
- Moris Topaz
- Department of Cardiology, Sourasky Tel Aviv Medical Center, Tel Aviv, Israel; Emeritus Plastic Surgery Unit, Hillel Yaffe Medical Center, Hadera, Israel.
| | - Ehud Chorin
- Department of Cardiology, Sourasky Tel Aviv Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arie Lorin Schwartz
- Department of Cardiology, Sourasky Tel Aviv Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviram Hochstadt
- Department of Cardiology, Sourasky Tel Aviv Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avraham Shotan
- Heart Institute, Hillel Yaffe Medical Center, Hadera, Israel; Heart Institute, Laniado Medical Center, Netanya, Israel; Adelson School of Medicine, Ariel University, Samaria, Israel
| | | | - Mark Kazatsker
- Heart Institute, Hillel Yaffe Medical Center, Hadera, Israel
| | | | - Guy Topaz
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Internal Medicine, Meir Medical Center, Kfar Saba, Israel
| | - Yoram Oron
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gilad Margolis
- Department of Cardiology, Sourasky Tel Aviv Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Nof
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Heart Institute, Sheba Medical Center, Tel-Hashomer, Israel
| | - Roy Beinart
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Heart Institute, Sheba Medical Center, Tel-Hashomer, Israel
| | - Michael Glikson
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Heart Institute, Sheba Medical Center, Tel-Hashomer, Israel; Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Hebrew University, Jerusalem, Israel
| | - Anna Mazo
- Department of Cardiology, Sourasky Tel Aviv Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Milman
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Heart Institute, Sheba Medical Center, Tel-Hashomer, Israel
| | - Michal Dekel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Infectious Disease Unit, Sourasky Tel Aviv Medical Center, Tel Aviv, Israel
| | - Shmuel Banai
- Department of Cardiology, Sourasky Tel Aviv Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Raphael Rosso
- Department of Cardiology, Sourasky Tel Aviv Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sami Viskin
- Department of Cardiology, Sourasky Tel Aviv Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Garcia R, Barnes S, Boukidjian R, Goss LK, Spencer M, Septimus EJ, Wright MO, Munro S, Reese SM, Fakih MG, Edmiston CE, Levesque M. Recommendations for change in infection prevention programs and practice. Am J Infect Control 2022; 50:1281-1295. [PMID: 35525498 PMCID: PMC9065600 DOI: 10.1016/j.ajic.2022.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 01/25/2023]
Abstract
Fifty years of evolution in infection prevention and control programs have involved significant accomplishments related to clinical practices, methodologies, and technology. However, regulatory mandates, and resource and research limitations, coupled with emerging infection threats such as the COVID-19 pandemic, present considerable challenges for infection preventionists. This article provides guidance and recommendations in 14 key areas. These interventions should be considered for implementation by United States health care facilities in the near future.
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Affiliation(s)
- Robert Garcia
- Department of Healthcare Epidemiology, State University of New York at Stony Brook, Stony Brook, NY.
| | - Sue Barnes
- Infection Preventionist (Retired), San Mateo, CA
| | | | - Linda Kaye Goss
- Department of Infection Prevention, The Queen's Health System, Honolulu, HI
| | | | - Edward J Septimus
- Department of Population Medicine, Harvard Medical School, Boston, MA
| | | | - Shannon Munro
- Department of Veterans Affairs Medical Center, Research and Development, Salem, VA
| | - Sara M Reese
- Quality and Patient Safety Department, SCL Health System Broomfield, CO
| | - Mohamad G Fakih
- Clinical & Network Services, Ascension Healthcare and Wayne State University School of Medicine, Grosse Pointe Woods, MI
| | | | - Martin Levesque
- System Infection Prevention and Control, Henry Ford Health, Detroit, MI
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Saving the Exposed Deep Brain Stimulation Implant: A Comprehensive Review of Implant Extrusion and Reconstructive Options. Ann Plast Surg 2022; 89:e21-e30. [DOI: 10.1097/sap.0000000000003318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Olsen T, Jørgensen OD, Nielsen JC, Thøgersen AM, Philbert BT, Frausing MHJP, Sandgaard NCF, Johansen JB. Risk factors for cardiac implantable electronic device infections: a nationwide Danish study. Eur Heart J 2022; 43:4946-4956. [PMID: 36263789 PMCID: PMC9748591 DOI: 10.1093/eurheartj/ehac576] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 08/05/2022] [Accepted: 09/29/2022] [Indexed: 01/12/2023] Open
Abstract
AIMS Cardiac implantable electronic device (CIED) infection is a severe complication to modern management of cardiac arrhythmias. The CIED type and the type of surgery are recognized as risk factors for CIED infections, but knowledge of patient-related risk factors is scarce. This study aimed to identify lifelong patient-related risk factors for CIED infections. METHODS AND RESULTS Consecutive Danish patients undergoing a CIED implantation or reoperation between January 1996 and April 2018 were included. The cohort consisted of 84 429 patients undergoing 108 494 CIED surgeries with a combined follow-up of 458 257 CIED-years. A total of 1556 CIED explantations were classified as either pocket (n = 1022) or systemic CIED infection (n = 534). Data were cross-linked with records from the Danish National Patient Registry and the Danish National Prescription Registry. Using multiple-record and multiple-event per subject proportional hazard analysis, specific patient-related risk factors were identified but with several variations amongst the subtypes of CIED infection. CIED reoperations were associated with the highest risk of pocket CIED infection but also CIED type, young age, and prior valvular surgery [hazard ratio (HR): 1.62, 95% confidence interval (CI): 1.29-2.04]. Severe renal insufficiency/dialysis (HR: 2.40, 95% CI: 1.65-3.49), dermatitis (HR: 2.80, 95% CI: 1.92-4.05), and prior valvular surgery (HR: 2.09, 95% CI: 1.59-2.75) were associated with the highest risk of systemic CIED infections. Congestive heart failure, ischaemic heart disease, malignancy, chronic obstructive pulmonary disease, and temporary pacing were not significant at multivariate analysis. CONCLUSION Specific comorbidities and surgical procedures were associated with a higher risk of CIED infections but with variations amongst pocket and systemic CIED infection. Pocket CIED infections were associated with CIED reoperations, young age and more complex type of CIED, whereas systemic CIED infections were associated with risk factors predisposing to bacteraemia.
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Affiliation(s)
- Thomas Olsen
- Corresponding author. Tel: +45 2635 1337, Fax: +45 6541 3003,
| | - Ole Dan Jørgensen
- Department of Heart, Lung and Vascular Surgery, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Region of Southern Denmark, Denmark,Danish Pacemaker and ICD Register, Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Region of Southern Denmark, Denmark
| | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Central Denmark Region, Denmark,Danish Pacemaker and ICD Register, Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Region of Southern Denmark, Denmark
| | - Anna Margrethe Thøgersen
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, North Denmark Region, Denmark
| | - Berit Thornvig Philbert
- Department of Cardiology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Capital Region of Denmark, Denmark,Danish Pacemaker and ICD Register, Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Region of Southern Denmark, Denmark
| | - Maria Hee Jung Park Frausing
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Central Denmark Region, Denmark
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Senaratne JM, Wijesundera J, Chhetri U, Beaudette D, Sander A, Hanninen M, Gulamhusein S, Senaratne M. Reduced incidence of CIED infections with peri- and post-operative antibiotic use in CRT-P/D and ICD procedures. Medicine (Baltimore) 2022; 101:e30944. [PMID: 36221436 PMCID: PMC9542667 DOI: 10.1097/md.0000000000030944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Higher cardiac implantable electronic device (CIED) infection incidence has been observed with cardiac resynchronization therapy pacemaker/defibrillator (CRT-P/D) and implantable cardioverter defibrillator (ICD) devices compared to traditional pacemakers with a 1.2% rate reported at 1 year. CIED infection management has high morbidity/mortality. A previous study from this institution demonstrated significantly reduced CIED infection rate when peri/post-operative antibiotics were given for traditional pacemaker procedures. The present study examines CIED infection incidence following peri/post-operative antibiotics during CRT-P/D and ICD procedures. All patients who underwent CRT-P/D and ICD procedures from 1996 to 2015 received IV cephalexin/clindamycin pre- and 8-hours post-procedure followed by 5 days of oral therapy. There were 427 procedures (CRT-P = 146 (34.2%); CRT-D = 142 (33.3%); ICD = 139 (32.6%)). Mean age at time of procedure was 61.6 years. Mean follow-up duration was 4.26 years. CIED infection occurred in 6 patients (ICD = 4, CRT-P = 1, CRT-D = 1), amounting to a rate of 4.96/1000 device-years in total. Times to CIED infection from procedure were: 1.7, 3.5, 6.7, 7.3, 7.9 and 9.2 years. Five out of 6 infections occurred in patients with repeat procedures. This study demonstrates that administration of peri- followed by post-operative antibiotics during CRT-P/D and ICD procedures is associated with a very low rate of CIED infection. This rate of 4.96 infections per 1000 device-years compares favorably to contemporary rates of 8.9 infections per 1000 device-years. Most CIED infections occur late and well-beyond the 1-year follow-up of the Prevention of Arrhythmia Device Infection Trial, the largest trial on this question. This approach should be considered pending a definitive trial.
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Affiliation(s)
- Janek Manoj Senaratne
- Division of Cardiology, University of Alberta, Edmonton, Canada
- Division of Cardiology, Grey Nuns Hospital, Edmonton, Canada
- Department of Medicine, University of Alberta, Edmonton, Canada
- Department of Critical Care Medicine, University of Alberta, Edmonton, Canada
- * Correspondence: Janek Senaratne, Department of Medicine, University of Alberta, 2939-66 Street NW, Edmonton, AB T6K 4C1, Canada (e-mail: )
| | | | - Usha Chhetri
- Division of Cardiology, Grey Nuns Hospital, Edmonton, Canada
| | - Diane Beaudette
- Division of Cardiology, Grey Nuns Hospital, Edmonton, Canada
| | - Andrea Sander
- Division of Cardiology, Grey Nuns Hospital, Edmonton, Canada
| | - Mike Hanninen
- Division of Cardiology, Grey Nuns Hospital, Edmonton, Canada
- Department of Medicine, University of Alberta, Edmonton, Canada
| | | | - Mano Senaratne
- Division of Cardiology, Grey Nuns Hospital, Edmonton, Canada
- Department of Medicine, University of Alberta, Edmonton, Canada
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Toriello F, Saviano M, Faggiano A, Gentile D, Provenzale G, Pollina AV, Gherbesi E, Barbieri L, Carugo S. Cardiac Implantable Electronic Devices Infection Assessment, Diagnosis and Management: A Review of the Literature. J Clin Med 2022; 11:5898. [PMID: 36233765 PMCID: PMC9570622 DOI: 10.3390/jcm11195898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 09/26/2022] [Accepted: 10/03/2022] [Indexed: 12/05/2022] Open
Abstract
The use of increasingly complex cardiac implantable electronic devices (CIEDs) has increased exponentially in recent years. One of the most serious complications in terms of mortality, morbidity and financial burden is represented by infections involving these devices. They may affect only the generator pocket or be generalised with lead-related endocarditis. Modifiable and non-modifiable risk factors have been identified and they can be associated with patient or procedure characteristics or with the type of CIED. Pocket and systemic infections require a precise evaluation and a specialised treatment which in most cases involves the removal of all the components of the device and a personalised antimicrobial therapy. CIED retention is usually limited to cases where infection is unlikely or is limited to the skin incision site. Optimal re-implantation timing depends on the type of infection and on the results of microbiological tests. Preventive strategies, in the end, include antibiotic prophylaxis before CIED implantation, the possibility to use antibacterial envelopes and the prevention of hematomas. The aim of this review is to investigate the pathogenesis, stratification, diagnostic tools and management of CIED infections.
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Affiliation(s)
- Filippo Toriello
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
- Department of Internal Medicine, Fondazione IRCCS Ca’ Granda—Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Massimo Saviano
- Department of Internal Medicine, Fondazione IRCCS Ca’ Granda—Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Andrea Faggiano
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
- Department of Internal Medicine, Fondazione IRCCS Ca’ Granda—Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Domitilla Gentile
- Department of Internal Medicine, Fondazione IRCCS Ca’ Granda—Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Giovanni Provenzale
- Department of Internal Medicine, Fondazione IRCCS Ca’ Granda—Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Alberto Vincenzo Pollina
- Department of Internal Medicine, Fondazione IRCCS Ca’ Granda—Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Elisa Gherbesi
- Department of Internal Medicine, Fondazione IRCCS Ca’ Granda—Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Lucia Barbieri
- Department of Internal Medicine, Fondazione IRCCS Ca’ Granda—Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Stefano Carugo
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
- Department of Internal Medicine, Fondazione IRCCS Ca’ Granda—Ospedale Maggiore Policlinico, 20122 Milan, Italy
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Khaloo P, Uzomah UA, Shaqdan A, Ledesma PA, Galvin J, Ptaszek LM, Ruskin JN. Outcomes of Patients Hospitalized With Cardiovascular Implantable Electronic Device-Related Infective Endocarditis, Prosthetic Valve Endocarditis, and Native Valve Endocarditis: A Nationwide Study, 2003 to 2017. J Am Heart Assoc 2022; 11:e025600. [PMID: 36000421 PMCID: PMC9496407 DOI: 10.1161/jaha.122.025600] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Most published reports describing outcomes of patients with cardiovascular implantable electronic device–related infective endocarditis (CIED‐IE) are single‐center studies with small patient sample sizes. The goal of this study was to utilize population‐based data to assess trends in CIED‐IE hospitalization and to compare outcomes between patients hospitalized with CIED‐IE, prosthetic valve endocarditis (PVE), and native valve endocarditis (NVE). Methods and Results A query of the National (Nationwide) Inpatient Sample (NIS) database between 2003 and 2017 identified 646 325 patients hospitalized with infective endocarditis in the United States of whom 585 974 (90%) had NVE, 27 257 (4.2%) had CIED‐IE, and 26 111 (4%) had PVE. There was a 509% increase in CIED‐IE hospitalizations in the United States from 2003 to 2017 (P trend<0.001). In‐hospital mortality and length of stay associated with CIED‐IE decreased during the study period from 15% and 20 days in 2003 to 9.7% and 19 days in 2017 (P trend=0.032 and 0.018, respectively). The in‐hospital mortality rate was lower in patients hospitalized with CIED‐IE (9.2%) than in patients with PVE (12%) and NVE (12%). Length of stay was longest in the CIED‐IE group (17 compared with 14 days for both NVE and PVE). Hospital costs were highest for the CIED‐IE group ($56 000 compared with $37 000 in NVE and $45 000 in PVE). Conclusions Despite the fact that the number of comorbidities per patient with CIED‐IE increased during the study period, mortality rate and hospital length of stay decreased. The mortality rate was significantly lower for patients with CIED‐IE than for patients with NVE and PVE. Patients with CIED‐IE had the longest lengths of stay and highest hospital costs.
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Affiliation(s)
- Pegah Khaloo
- Cardiac Arrhythmia Service MGH Heart Center, Massachusetts General Hospital Boston MA
| | | | - Ayman Shaqdan
- Cardiac Arrhythmia Service MGH Heart Center, Massachusetts General Hospital Boston MA
| | - Pablo A Ledesma
- Cardiac Arrhythmia Service MGH Heart Center, Massachusetts General Hospital Boston MA
| | - Jennifer Galvin
- Cardiac Arrhythmia Service MGH Heart Center, Massachusetts General Hospital Boston MA
| | - Leon M Ptaszek
- Cardiac Arrhythmia Service MGH Heart Center, Massachusetts General Hospital Boston MA
| | - Jeremy N Ruskin
- Cardiac Arrhythmia Service MGH Heart Center, Massachusetts General Hospital Boston MA
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Prevention and Management of Cardiac Implantable Electronic Device Infections: State-of-the-Art and Future Directions. Heart Lung Circ 2022; 31:1482-1492. [PMID: 35989213 DOI: 10.1016/j.hlc.2022.06.690] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 06/09/2022] [Accepted: 06/19/2022] [Indexed: 11/23/2022]
Abstract
Cardiac implantable electronic device (CIED) infection is an increasingly common complication of device therapy. CIED infection confers significant patient morbidity and health care expenditure, hence it is essential that clinicians recognise the contemporary strategies for predicting, reducing and treating these events. Recent technological advances-in particular, the development of antimicrobial envelopes, leadless devices and validated risk scores-present decision-makers with novel strategies for managing this expanding patient population. This review summarises the key issues facing CIED patients and their physicians, and explores the supporting evidence for the latest therapeutic developments in this field.
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48
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Phillips P, Krahn AD, Andrade JG, Chakrabarti S, Thompson CR, Harris DJ, Forman JM, Karim SS, Sterns LD, Fedoruk LM, Partlow E, Bashir J. Treatment and Prevention of Cardiovascular Implantable Electronic Device (CIED) Infections. CJC Open 2022; 4:946-958. [DOI: 10.1016/j.cjco.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/03/2022] [Indexed: 10/15/2022] Open
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Infective Endocarditis in High-Income Countries. Metabolites 2022; 12:metabo12080682. [PMID: 35893249 PMCID: PMC9329978 DOI: 10.3390/metabo12080682] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 01/27/2023] Open
Abstract
Infective endocarditis remains an illness that carries a significant burden to healthcare resources. In recent times, there has been a shift from Streptococcus sp. to Staphylococcus sp. as the primary organism of interest. This has significant consequences, given the virulence of Staphylococcus and its propensity to form a biofilm, rendering non-surgical therapy ineffective. In addition, antibiotic resistance has affected treatment of this organism. The cohorts at most risk for Staphylococcal endocarditis are elderly patients with multiple comorbidities. The innovation of transcatheter technologies alongside other cardiac interventions such as implantable devices has contributed to the increased risk attributable to this cohort. We examined the pathophysiology of infective endocarditis carefully. Inter alia, the determinants of Staphylococcus aureus virulence, interaction with host immunity, as well as the discovery and emergence of a potential vaccine, were investigated. Furthermore, the potential role of prophylactic antibiotics during dental procedures was also evaluated. As rates of transcatheter device implantation increase, endocarditis is expected to increase, especially in this high-risk group. A high level of suspicion is needed alongside early initiation of therapy and referral to the heart team to improve outcomes.
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50
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Chesdachai S, Go JR, Hassett LC, Baddour LM, DeSimone DC. The utility of postoperative systemic antibiotic prophylaxis following cardiovascular implantable electronic device implantation: A systematic review and meta-analysis. Pacing Clin Electrophysiol 2022; 45:940-949. [PMID: 35819103 DOI: 10.1111/pace.14561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/08/2022] [Accepted: 06/26/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is insufficient evidence regarding postoperative systemic antibiotic prophylaxis use for more than 24 hours following cardiovascular implantable electronic devices (CIED) implantation and its impact on infection prevention. However, this strategy remains a common practice in many institutions. METHODS We conducted a systematic review and meta-analysis including studies that compared the outcomes of patients: 1) who received preoperative plus 24 hours or more of postoperative antibiotic prophylaxis (intervention group); and 2) who received either preoperative only or preoperative plus less than 24 hours of antibiotic prophylaxis (control group). Risk of bias was assessed with ROBINS-I and ROB-2 tools. Risk ratio (RR) was pooled using random-effect meta-analyses with inverse variance method. RESULTS Eight studies that included two randomized controlled trials (RCTs) and six cohort studies with a total of 26,187 patients were included in the analysis. Overall, there were no differences in outcomes between the two groups, which included rates of CIED infection (RR 0.77, 95% CI 0.42, 1.42), mortality (RR 1.19, 95% CI 0.69, 2.06), pocket hematoma (RR 1.15, 95% CI 0.44, 3.00) or reintervention (RR 0.87, 95% CI 0.22, 3.46). Of note, the results were primarily impacted by the larger RCT. CONCLUSIONS There was no benefit of postoperative antibiotic prophylaxis for more than 24 hours following CIED implantation in the current systematic review and meta-analysis. This supports the practice advocated by current guidelines which foster antibiotic stewardship and may result in reductions of adverse drug events, selection for antibiotic resistance, and financial costs of prolonged postoperative antibiotic prophylaxis. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Supavit Chesdachai
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - John R Go
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Larry M Baddour
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel C DeSimone
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
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