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Göçer K, Aykan AÇ, Balcioğlu AS, Aksu E, Kaniyolu M, Dağli M, Göçer NS. Factors of mortality in patients with cardiac implantable electronic device: 5-year experience. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e20230998. [PMID: 38716936 PMCID: PMC11068399 DOI: 10.1590/1806-9282.20230998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 11/12/2023] [Indexed: 05/12/2024]
Abstract
OBJECTIVE The use of cardiac implantable electronic devices has increased in recent years. It has also brought some issues. Among these, the complications of cardiac implantable electronic devices infection and pocket hematoma are difficult to manage. It can be fatal with the contribution of patient-related risk factors. In this study, we aimed to find mortality rates in patients who developed cardiac implantable electronic devices infection and pocket hematoma over 5 years. We also investigated the risk factors affecting mortality in patients with cardiac implantable electronic devices. METHODS A total of 288 cardiac implantable electronic devices patients were evaluated. Demographic details, history, and clinical data of all patients were recorded. Cardiac implantable electronic devices infection was defined according to the modified Duke criteria. The national registry was used to ascertain the mortality status of the patients. The patients were divided into two groups (exitus and survival groups). In addition, the pocket hematoma was defined as significant bleeding at the pocket site after cardiac implantable electronic devices placement. RESULTS The cardiac implantable electronic devices infection was similar in both groups (p=0.919), and the pocket hematoma was higher in the exitus group (p=0.019). The exitus group had higher usage of P2Y12 inhibitors (p≤0.001) and novel oral anticoagulants (p=0.031). The Cox regression analysis, including mortality-related factors, revealed that renal failure is the most significant risk factor for mortality. Renal failure was linked to a 2.78-fold higher risk of death. CONCLUSION No correlation was observed between cardiac implantable electronic devices infection and mortality, whereas pocket hematoma was associated with mortality. Furthermore, renal failure was the cause of the highest mortality rate in patients with cardiac implantable electronic devices.
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Affiliation(s)
- Kemal Göçer
- Kahramanmaras Sutcu Imam University, Faculty of Medicine, Department of Cardiology – Kahramanmaraş, Turkey
| | - Ahmet Çağrı Aykan
- Kahramanmaras Sutcu Imam University, Faculty of Medicine, Department of Cardiology – Kahramanmaraş, Turkey
| | - Akif Serhat Balcioğlu
- Kahramanmaras Sutcu Imam University, Faculty of Medicine, Department of Cardiology – Kahramanmaraş, Turkey
| | - Ekrem Aksu
- Kahramanmaras Sutcu Imam University, Faculty of Medicine, Department of Cardiology – Kahramanmaraş, Turkey
| | - Murat Kaniyolu
- Kahramanmaras Sutcu Imam University, Faculty of Medicine, Department of Cardiology – Kahramanmaraş, Turkey
| | - Musa Dağli
- Kahramanmaras Sutcu Imam University, Faculty of Medicine, Department of Cardiology – Kahramanmaraş, Turkey
| | - Naime Sıla Göçer
- Necip Fazıl City Hospital, Department of Infectious Diseases – Kahramanmaraş, Turkey
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Colditz M, Heard T, Silburn P, Coyne T. Do Antibiotic-Impregnated Envelopes Prevent Deep Brain Stimulation Implantable Pulse Generator Infections? A Prospective Cohort Study. Stereotact Funct Neurosurg 2024; 102:137-140. [PMID: 38461818 PMCID: PMC11152020 DOI: 10.1159/000536478] [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: 04/14/2023] [Accepted: 01/15/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION Infection after deep brain stimulation (DBS) implanted pulse generator (IPG) replacement is uncommon but when it occurs can cause significant clinical morbidity, often resulting in partial or complete DBS system removal. An antibiotic absorbable envelope developed for cardiac implantable electronic devices (IEDs), which releases minocycline and rifampicin for a minimum of 7 days, was shown in the WRAP-IT study to reduce cardiac IED infections for high-risk cardiac patients. We aimed to assess whether placing an IPG in the same antibiotic envelope at the time of IPG replacement reduced the IPG infection rate. METHODS Following institutional ethics approval (UnitingCare HREC), patients scheduled for IPG change due to impending battery depletion were prospectively randomised to receive IPG replacement with or without an antibiotic envelope. Patients with a past history of DBS system infection were excluded. Patients underwent surgery with standard aseptic neurosurgical technique [J Neurol Sci. 2017;383:135-41]. Subsequent infection requiring antibiotic therapy and/or IPG removal or revision was recorded. RESULTS A total of 427 consecutive patients were randomised from 2018 to 2021 and followed for a minimum of 12 months. No patients were lost to follow-up. At the time of IPG replacement, 200 patients received antibiotic envelope (54 female, 146 male, mean age 72 years), and 227 did not (43 female, 184 male, mean age 71 years). The two groups were homogenous for risk factors of infection. The IPG replacement infection rate was 2.1% (9/427). There were six infections, which required antibiotic therapy and/or IPG removal, in the antibiotic envelope group (6/200) and three in the non-envelope group (3/227) (p = 0.66). CONCLUSION This prospective randomised study did not find that an antibiotic envelope reduced the IPG infection rate in our 427 patients undergoing routine DBS IPG replacement. Further research to reduce IPG revisions and infections in a cost-effective manner is required.
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Affiliation(s)
- Michael Colditz
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Tomas Heard
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Peter Silburn
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Terry Coyne
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
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Jaroonpipatkul S, Sathapanasiri T, Aungthararak S, Pokawattana A, Navaravong L. Extra-articular bloody tophi in pacemaker pocket: A case report. HeartRhythm Case Rep 2023; 9:701-703. [PMID: 38047206 PMCID: PMC10691936 DOI: 10.1016/j.hrcr.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Affiliation(s)
- Surachat Jaroonpipatkul
- Division of Cardiology, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
| | - Thipsukhon Sathapanasiri
- Division of Rheumatology, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
| | - Sungchai Aungthararak
- Division of Rheumatology, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
| | - Apichai Pokawattana
- Division of Cardiology, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
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Kobalava ZD, Kotova EO. [Global and national trends in the evolution of infective endocarditis]. KARDIOLOGIIA 2023; 63:3-11. [PMID: 36749195 DOI: 10.18087/cardio.2023.1.n2307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 10/28/2022] [Indexed: 02/08/2023]
Abstract
For the recent 20 years, substantial changes have occurred in all aspects of infectious endocarditis (IE), the evolution of risk factors, modernization of diagnostic methods, therapeutic and preventive approaches. The global trends are characterized by increased IE morbidity among people older than 65 who use intravenous psychoactive drugs. The epidemiological trend is represented by reduced roles of chronic rheumatic heart disease and congenital heart defects, increased proportion of IE associated with medical care, valve replacement, installation of intracardiac devices, and increased contribution of Staphylococcus spp. and Enterococcus spp. to the IE etiology. Additional visualization methods (fluorodeoxyglucose positron emission tomography with 18F-fludesoxyglucose (18F-FDG PET-CT), labeled white blood cell single-photon emission computed tomography (SPECT), and modernization of the etiological diagnostic algorithm for determining the true pathogen (immunochemistry, polymerase chain reaction, sequencing) also become increasingly important. The COVID-19 pandemic has also adversely contributed to the IE epidemiology. New prospects of treatment have emerged, such as bacteriophages, lysins, oral antibacterial therapy, minimally invasive surgical strategies (percutaneous mechanical aspiration), endovascular mechanical embolectomy. The physicians' compliance with clinical guidelines (CG) is low, which contributes to the high rate of adverse outcomes of IE, while simple adherence to the CG together with more frequent use of surgical treatment doubles survival. Systematic adherence to CG, timely prevention and implementation of the Endocarditis Team into practice play the decisive role in a favorable prognosis of dynamically changing IE. This article presents the authors' own data that confirm the evolutionary trends of current IE.
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Affiliation(s)
- Zh D Kobalava
- Russian University of Peoples' Friendship; Vinogradov Municipal Clinical Hospital
| | - E O Kotova
- Russian University of Peoples' Friendship; Vinogradov Municipal Clinical Hospital
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Cardiac Implantable Electronic Devices Infection Assessment, Diagnosis and Management: A Review of the Literature. J Clin Med 2022; 11:jcm11195898. [PMID: 36233765 PMCID: PMC9570622 DOI: 10.3390/jcm11195898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [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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Fensman SK, Grove EL, Johansen JB, Jørgensen OD, Frausing MHJP, Kirkfeldt RE, Nielsen JC. Predictors of pocket hematoma after cardiac implantable electronic device surgery: A nationwide cohort study. J Arrhythm 2022; 38:748-755. [PMID: 36237873 PMCID: PMC9535764 DOI: 10.1002/joa3.12769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/29/2022] [Accepted: 08/04/2022] [Indexed: 11/07/2022] Open
Abstract
Purpose Methods Results Conclusion
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Affiliation(s)
| | - Erik Lerkevang Grove
- Department of CardiologyAarhus University HospitalAarhusDenmark
- Department of Clinical Medicine, Faculty of HealthAarhus UniversityAarhusDenmark
| | - Jens Brock Johansen
- Department of CardiologyOdense University HospitalOdenseDenmark
- The Danish Pacemaker and ICD RegisterOdense UniversityOdenseDenmark
| | - Ole Dan Jørgensen
- The Danish Pacemaker and ICD RegisterOdense UniversityOdenseDenmark
- Department of Heart, Lung, and Vascular SurgeryOdense University HospitalOdenseDenmark
| | | | - Rikke Esberg Kirkfeldt
- Department of CardiologyAarhus University HospitalAarhusDenmark
- The Danish Pacemaker and ICD RegisterOdense UniversityOdenseDenmark
| | - Jens Cosedis Nielsen
- Department of CardiologyAarhus University HospitalAarhusDenmark
- Department of Clinical Medicine, Faculty of HealthAarhus UniversityAarhusDenmark
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Ngiam JN, Liong TS, Sim MY, Chew NWS, Sia CH, Chan SP, Lim TW, Yeo TC, Tambyah PA, Loh PH, Poh KK, Kong WKF. Risk Factors for Mortality in Cardiac Implantable Electronic Device (CIED) Infections: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11113063. [PMID: 35683451 PMCID: PMC9181812 DOI: 10.3390/jcm11113063] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/22/2022] [Accepted: 05/25/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Infections following cardiac implantable electronic device (CIED) implantation can require surgical device removal and often results in significant cost, morbidity, and potentially mortality. We aimed to systemically review the literature and identify risk factors associated with mortality following CIED infection. Methods: Electronic searches (up to June 2021) were performed on PubMed and Scopus. Twelve studies (10 retrospective, 2 prospective cohort studies) were included for analysis. Meta-analysis was conducted with the restricted maximum likelihood method, with mortality as the outcome. The overall mortality was 13.7% (438/1398) following CIED infection. Results: On meta-analysis, the male sex (OR 0.77, 95%CI 0.57–1.01, I2 = 2.2%) appeared to have lower odds for mortality, while diabetes mellitus appeared to be associated with higher mortality (OR 1.47, 95%CI 0.67–3.26, I2 = 81.4%), although these trends did not reach statistical significance. Staphylococcus aureus as the causative organism (OR 2.71, 95%CI 1.76–4.19, I2 = 0.0%), presence of heart failure (OR 1.92, 95%CI 1.42–4.19, I2 = 0.0%) and embolic phenomena (OR 4.00, 95%CI 1.67–9.56, I2 = 69.8%) were associated with higher mortality. Surgical removal of CIED was associated with lower mortality compared with conservative management with antibiotics alone (OR 0.22, 95%CI 0.09–0.50, I2 = 62.8%). Conclusion: We identified important risk factors associated with mortality in CIED infections, including Staphyloccocus aureus as the causative organism, and the presence of complications, such as heart failure and embolic phenomena. Surgery, where possible, was associated with better outcomes.
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Affiliation(s)
- Jinghao Nicholas Ngiam
- Division of Infectious Diseases, Department of Medicine, National University Health System, Singapore 119228, Singapore; (J.N.N.); (P.A.T.)
| | - Tze Sian Liong
- Department of Medicine, National University Health System, Singapore 119228, Singapore; (T.S.L.); (M.Y.S.)
| | - Meng Ying Sim
- Department of Medicine, National University Health System, Singapore 119228, Singapore; (T.S.L.); (M.Y.S.)
| | - Nicholas W. S. Chew
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore 119074, Singapore; (N.W.S.C.); (C.-H.S.); (T.W.L.); (T.-C.Y.); (P.H.L.); (K.K.P.)
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore 119074, Singapore; (N.W.S.C.); (C.-H.S.); (T.W.L.); (T.-C.Y.); (P.H.L.); (K.K.P.)
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore;
| | - Siew Pang Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore;
- Cardiovascular Research Institute, National University Health System, Singapore 119074, Singapore
| | - Toon Wei Lim
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore 119074, Singapore; (N.W.S.C.); (C.-H.S.); (T.W.L.); (T.-C.Y.); (P.H.L.); (K.K.P.)
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore;
| | - Tiong-Cheng Yeo
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore 119074, Singapore; (N.W.S.C.); (C.-H.S.); (T.W.L.); (T.-C.Y.); (P.H.L.); (K.K.P.)
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore;
| | - Paul Anantharajah Tambyah
- Division of Infectious Diseases, Department of Medicine, National University Health System, Singapore 119228, Singapore; (J.N.N.); (P.A.T.)
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore;
- Infectious Diseases Translational Research Programme, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Poay Huan Loh
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore 119074, Singapore; (N.W.S.C.); (C.-H.S.); (T.W.L.); (T.-C.Y.); (P.H.L.); (K.K.P.)
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore;
| | - Kian Keong Poh
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore 119074, Singapore; (N.W.S.C.); (C.-H.S.); (T.W.L.); (T.-C.Y.); (P.H.L.); (K.K.P.)
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore;
| | - William K. F. Kong
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore 119074, Singapore; (N.W.S.C.); (C.-H.S.); (T.W.L.); (T.-C.Y.); (P.H.L.); (K.K.P.)
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore;
- Correspondence: ; Tel.: +65-67722476; Fax: +65-68722998
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Arshad V, Talha KM, Baddour LM. Epidemiology of infective endocarditis: novel aspects in the twenty-first century. Expert Rev Cardiovasc Ther 2022; 20:45-54. [PMID: 35081845 DOI: 10.1080/14779072.2022.2031980] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The epidemiology of infective endocarditis (IE) in this millennium has changed with emergence of new risk factors and reemergence of others. This, coupled with modifications in national guidelines in the setting of a pandemic, prompted an address of the topic. AREAS COVERED Our goal is to provide a contemporary review of IE epidemiology considering changing incidence of rheumatic heart disease (RHD), cardiac device implantation, and injection drug use (IDU), with SARS-CoV-2 pandemic as the backdrop. METHODS PubMed and Google Scholar were used to identify studies of interest. EXPERT OPINION Our experience over the past two decades verifies the notion that there is not one 'textbook' profile of IE. Multiple factors have dramatically impacted IE epidemiology, and these factors differ, based, in part on geography. RHD has declined in many areas of the world, whereas implanted cardiovascular devices-related IE has grown exponentially. Perhaps the most influential, at least in areas of the United States, is injection drug use complicating the opioid epidemic. Healthy younger individuals contracting a potentially life-threatening infection has been tragic. In the past year, epidemiological changes due to the COVID-19 pandemic have also occurred. No doubt, changes will characterize IE in the future and serial review of the topic is warranted.
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Affiliation(s)
- Verda Arshad
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Khawaja M Talha
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Larry M Baddour
- Department of Cardiovascular Disease, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.,Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
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