1
|
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.
Collapse
|
2
|
Khubrani RM, Alghamdi AS, Alsubaie AA, Alenazi T, Almutairi A, Alsunaydi F. Rate of Cardiovascular Implantable Electronic Device-Related Infection at a Tertiary Hospital in Saudi Arabia: A Retrospective Cohort Study. Cureus 2022; 14:e27078. [PMID: 35989761 PMCID: PMC9389022 DOI: 10.7759/cureus.27078] [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] [Accepted: 07/20/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction Cardiovascular implantable electronic devices (CIEDs) are long-term cardiac treatments that address a variety of cardiac diseases. In the recent years, a steady growth has been noticed in CIEDs, mainly due to expanding indications for their usage. Possible device-related infection, whether pocket or systemic, which leads to high morbidity and mortality, is one of the most worrying complications. In addition, there are limited studies conducted on the topic of CIED infection rate and their clinical presentation both regionally and locally. Methods In this retrospective cohort study, we reviewed the medical records of all patients with CIEDs who presented to our medical center (implanted, followed up, or referred to our hospital) between January 2016 and January 2019.The medical records were extracted from the BestCare electronic medical records system (ezCaretech Co, Seoul, Korea). All consecutive patients were included as we had no exclusion criteria. Results During the three years of the study period, a total of 612 patients with CIEDs were identified at our medical center. Among this cohort, 436 subjects (71.2%) were male and 176 (28.8%) were female. Thirty-four patients experienced device-related infections from among the total patient population (n = 612) who presented with CIEDs between January 2016 and January 2019, for a total rate of 5.6%. Of the infected patients, 29 (85%) presented with local infections and five (15%) presented with systemic infections. Conclusion The infection rate of 5.6% observed in this study was higher than expected. Therefore, we conclude that action should be taken to reduce infection rates at our medical center to at least that seen in prior studies or below that, if possible. Moreover, we found that CIED infections were often caused by Staphylococcus species and commonly affected the elderly and patients with chronic diseases such as diabetes and hypertension. Most of the identified cases were local infections, although systemic infections were common in those with renal disease. Further studies are needed to control the risk factors and to better understand the role of antibiotics, antiseptic prophylaxis, and other methods in avoiding CIED infection and associated complications.
Collapse
|
3
|
Longtin Y, Gervais P, Birnie DH, Wang J, Alings M, Philippon F, Parkash R, Manlucu J, Angaran P, Rinne C, Coutu B, Low RA, Essebag V, Morillo C, Redfearn D, Toal S, Becker G, Degrâce M, Thibault B, Crystal E, Tung S, LeMaitre J, Sultan O, Bennett M, Bashir J, Ayala-Paredes F, Rioux L, Hemels MEW, Bouwels LHR, Exner DV, Dorian P, Connolly SJ, Krahn AD. Impact of Choice of Prophylaxis on the Microbiology of Cardiac Implantable Electronic Device Infections: Insights From the Prevention of Arrhythmia Device Infection Trial (PADIT). Open Forum Infect Dis 2021; 8:ofab513. [PMID: 34859113 PMCID: PMC8632784 DOI: 10.1093/ofid/ofab513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 10/12/2021] [Indexed: 01/01/2023] Open
Abstract
Background The Prevention of Arrhythmia Device Infection Trial (PADIT) investigated whether intensification of perioperative prophylaxis could prevent cardiac implantable electronic device (CIED) infections. Compared with a single dose of cefazolin, the perioperative administration of cefazolin, vancomycin, bacitracin, and cephalexin did not significantly decrease the risk of infection. Our objective was to compare the microbiology of infections between study arms in PADIT. Methods This was a post hoc analysis. Differences between study arms in the microbiology of infections were assessed at the level of individual patients and at the level of microorganisms using the Fisher exact test. Results Overall, 209 microorganisms were reported from 177 patients. The most common microorganisms were coagulase-negative staphylococci (CoNS; 82/209 [39.2%]) and S. aureus (75/209 [35.9%]). There was a significantly lower proportion of CoNS in the incremental arm compared with the standard arm (30.1% vs 46.6%; P = .04). However, there was no significant difference between study arms in the frequency of recovery of other microorganisms. In terms of antimicrobial susceptibility, 26.5% of microorganisms were resistant to cefazolin. CoNS were more likely to be cefazolin-resistant in the incremental arm (52.2% vs 26.8%, respectively; P = .05). However, there was no difference between study arms in terms of infections in which the main pathogen was sensitive to cefazolin (77.8% vs 64.3%; P = .10) or vancomycin (90.8% vs 90.2%; P = .90). Conclusions Intensification of the prophylaxis led to significant changes in the microbiology of infections, despite the absence of a decrease in the overall risk of infections. These findings provide important insight on the physiopathology of CIED infections. Trial registration NCT01002911.
Collapse
Affiliation(s)
- Yves Longtin
- Jewish General Hospital Sir Mortimer B. Davis, McGill University, Montreal, Quebec, Canada.,Lady Davis Research Institute, Montreal, Quebec, Canada
| | - Philippe Gervais
- Institut universitaire de cardiologie et de pneumologie de Québec, Laval University, Quebec City, Quebec, Canada
| | - David H Birnie
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Jia Wang
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Marco Alings
- Amphia Ziekenhuis & Working Group on Cardiovascular Research (WCN), Breda, the Netherlands
| | - François Philippon
- Institut universitaire de cardiologie et de pneumologie de Québec, Laval University, Quebec City, Quebec, Canada
| | - Ratika Parkash
- Queen Elizabeth II Health Science Center, Halifax, Nova Scotia, Canada
| | - Jaimie Manlucu
- Lawson Health Research Institute, London Health Sciences, Western University, London, Ontario, Canada
| | - Paul Angaran
- Department of Medicine, University of Toronto, Division of Cardiology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Claus Rinne
- St. Mary's General Hospital, Kitchener, Ontario, Canada
| | - Benoit Coutu
- Centre hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada
| | - R Aaron Low
- Chinook Regional Hospital, Lethbridge, Alberta, Canada
| | - Vidal Essebag
- McGill University Health Center, Montreal, Quebec, Canada
| | - Carlos Morillo
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Damian Redfearn
- Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Satish Toal
- Horizon Health Network, Saint John, New Brunswick, Canada
| | - Giuliano Becker
- Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, Quebec, Canada
| | | | | | - Eugene Crystal
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Stanley Tung
- St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - John LeMaitre
- Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Omar Sultan
- Regina General Hospital, Saskatchewan Health Authority, Regina, Saskatchewan, Canada
| | - Matthew Bennett
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Jamil Bashir
- St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Felix Ayala-Paredes
- Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, Quebec, Canada
| | - Leon Rioux
- Centre de santé et de services sociaux de Rimouski-Neigette (CSSSRN), Rimouski, Quebec, Canada
| | - Martin E W Hemels
- Ziekenhuis Rijnstate, Arnhem, and Radboud University Medical Centre, Nijmegen, the Netherlands
| | | | - Derek V Exner
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Paul Dorian
- Department of Medicine, University of Toronto, Division of Cardiology, St. Michael Hospital, Toronto, Ontario, Canada
| | - Stuart J Connolly
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Andrew D Krahn
- University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
4
|
Hörnsten J, Axelsson L, Westling K. Cardiac Implantable Electronic Device Infections; Long-Term Outcome after Extraction and Antibiotic Treatment. Infect Dis Rep 2021; 13:627-635. [PMID: 34287314 PMCID: PMC8293088 DOI: 10.3390/idr13030059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 11/16/2022] Open
Abstract
Background: The aim of the study was to examine the treatment outcome for patients with cardiovascular implantable electronic device (CIED) infections after extraction. Methods: Patients who underwent CIED extractions due to an infection at Karolinska University Hospital 2006–2015 were analyzed. Results: In total, 165 patients were reviewed, 104 (63%) with pocket infection and 61 (37%) with systemic infection. Of the patients with systemic infection, 34 and 25 patients fulfilled the criteria for definite and possible endocarditis, respectively. Complications after extraction occurred only in one patient. Reimplantation was made after a mean of 9.5 days and performed in 81% of those with pocket infection and 44.3% in systemic infection. Infection with the new device occurred in 4.6%. The mean length of hospital stay for patients with pocket infection was 5.7 days, compared to 38.6 days in systemic infection. One-year mortality was 7.7% and 22.2% in pocket infection and systemic infection, respectively. Patients with Staphylococcus aureus infection had a higher mortality. Conclusions: In this study, the majority of the patients had a pocket CIED infection, with a short hospital stay. Patients with a systemic infection, and S. aureus etiology, had a prolonged hospital stay and a higher mortality.
Collapse
Affiliation(s)
- Jonas Hörnsten
- Department of Cardiology, Karolinska University Hospital, 17176 Stockholm, Sweden;
| | - Louise Axelsson
- Department of Medicine, Division of Infectious Diseases and Dermatology, Karolinska Institutet, 17177 Solna, Sweden;
| | - Katarina Westling
- Department of Medicine, Division of Infectious Diseases and Dermatology, Karolinska Institutet, 17177 Solna, Sweden;
- Department of Infectious Diseases, Karolinska University Hospital, 14186 Stockholm, Sweden
- Correspondence:
| |
Collapse
|
5
|
Mateos Gaitán R, Boix-Palop L, Muñoz García P, Mestres CA, Marín Arriaza M, Pedraz Prieto Á, de Alarcón Gonzalez A, Gutiérrez Carretero E, Hernández Meneses M, Goenaga Sánchez MÁ, Cobo Belaustegui M, Oteo Revuelta JA, Gainzarain Arana JC, García Vázquez E, Martínez-Sellés M. Infective endocarditis in patients with cardiac implantable electronic devices: a nationwide study. Europace 2021; 22:1062-1070. [PMID: 32390046 DOI: 10.1093/europace/euaa076] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 03/12/2020] [Indexed: 12/17/2022] Open
Abstract
AIMS Patients with infective endocarditis (IE) frequently have cardiac implantable electronic devices (CIEDs). Here, we aim to define the clinical profile and prognostic factors of IE in these patients. METHODS AND RESULTS Infective endocarditis cases were prospectively identified in the Spanish National Endocarditis Registry. From 3996 IE, 708 (17.7%) had a CIED and 424 CIED-related IE (lead vegetation). Patients with a CIED were older (68 ± 11 vs. 73 ± 8 years); had more comorbidities {pulmonary disease [176 (24.8%) vs. 545 (16.7%)], renal disease [239 (33.8%) vs. 740 (22.7%)], diabetes [248 (35.0%) vs. 867 (26.6%)], and heart failure [348 (49.2%) vs. 978 (29.9%)]}; and fewer complications {intracardiac destruction [106 (15%) vs. 1077 (33.1%)], heart failure [215 (30.3%) vs. 1340 (41.1%)], embolism [107 (15.1%) vs. 714 (21.9%)], and neurological involvement [77 (10.8%) vs. 702 (21.5%)]} (all P-values <0.001) in comparison to subjects without a CIED. In-hospital mortality was similar in patients with and without CIED [171 (24.2%) vs. 881 (27.0%), P = 0.82]. In subjects with a CIED, CIED-related IE was independently associated with in-hospital survival: odds ratio (OR) 0.4 [95% confidence interval (CI) 0.3-0.7, P = 0.001]. Surgery was independently associated with in-hospital survival in CIED-related IE: OR 0.4 (95% CI 0.2-0.7, P = 0.004); but not in subjects with valve IE and no CIED lead involvement: OR 0.9 (95% CI 0.5-1.7, P = 0.77). CONCLUSION Over a sixth of IE patients have a CIED. This group of patients is older, with more comorbidities and fewer IE-related complications in comparison to subjects without a CIED. In-hospital mortality was similar in patients with and without a CIED.
Collapse
Affiliation(s)
- Roberto Mateos Gaitán
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, CIBERCV, Calle Doctor Esquerdo, 46, 28007 Madrid, Spain
| | - Lucía Boix-Palop
- Unit of Infectious Diseases and Microbiology, Department of Internal Medicine, Hospital Universitari Mútua de Terrassa, Barcelona, Spain
| | - Patricia Muñoz García
- Clinical Unit of Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Gregorio Marañón Health Research Institute, CIBER Enfermedades Respiratorias-CIBERES, Madrid, Spain
| | - Carlos A Mestres
- Department of Cardiovascular Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Mercedes Marín Arriaza
- Clinical Unit of Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Gregorio Marañón Health Research Institute, CIBER Enfermedades Respiratorias-CIBERES, Madrid, Spain
| | - Álvaro Pedraz Prieto
- Department of Cardiovascular Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Arístides de Alarcón Gonzalez
- 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, Sevilla, Spain
| | - Encarnación Gutiérrez Carretero
- Cardiac Surgery Department, University of Sevilla/CSIC/University Hospital Virgen del Rocío Seville, Institute of Biomedicine-Sevilla (IBiS), CIBERCV, Sevilla, Spain
| | | | | | | | - José Antonio Oteo Revuelta
- Department of Infectious Diseases, Hospital Universitario San Pedro, Centre for Biomedical Research La Rioja (CIBIR), Logroño, Spain
| | | | - Elisa García Vázquez
- Department of Internal Medicine/Infectious Diseases, Hospital Clínico Universitario Virgen de la Arrixaca, Biohealth Research Institute (IMIB), Faculty of Medicine, Universidad de Murcia, Murcia, Spain
| | - Manuel Martínez-Sellés
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, CIBERCV, Calle Doctor Esquerdo, 46, 28007 Madrid, Spain.,Universidad Europea, Universidad Complutense, Madrid, Spain
| |
Collapse
|
6
|
Golamari R, Sahu N, Vunnam R, Bhatt D, Thapa R, Patel R, Jain R. Rare enough ? Cardiac Device-related pocket Infection due to Mycobacterium fortuitum. Clin Case Rep 2021; 9:1566-1570. [PMID: 33768890 PMCID: PMC7981651 DOI: 10.1002/ccr3.3829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 12/23/2020] [Accepted: 01/05/2021] [Indexed: 11/12/2022] Open
Abstract
Nontuberculous mycobacteria are rare causes of cardiac implantable electronic device (CIED)-related infections and may lead to device-related endocarditis, so preventing them is key. We present a case of CIED-related pocket infection due to Mycobacterium fortuitum which highlights the challenges in management of such infections.
Collapse
Affiliation(s)
- Reshma Golamari
- Assistant Professor of MedicineDepartment of Hospital MedicinePenn State Health Milton S. Hershey Medical CenterHersheyPennsylvaniaUSA
| | - Nitasa Sahu
- Assistant Professor of MedicineDepartment of Hospital MedicinePenn State Health Milton S. Hershey Medical CenterHersheyPennsylvaniaUSA
| | - Rama Vunnam
- Assistant Professor of MedicineDepartment of Hospital MedicinePenn State Health Milton S. Hershey Medical CenterHersheyPennsylvaniaUSA
| | - Dhirisha Bhatt
- Assistant Professor of MedicineDepartment of Hospital MedicinePenn State Health Milton S. Hershey Medical CenterHersheyPennsylvaniaUSA
| | - Rameet Thapa
- Department of Infectious DiseaseUPMC Western MarylandCumberlandMarylandUSA
| | - Ravi Patel
- Resident PhysicianDepartment of Internal MedicinePenn State Health Milton S. Hershey Medical CenterHersheyPennsylvaniaUSA
| | - Rohit Jain
- Assistant Professor of MedicineDepartment of Hospital MedicinePenn State Health Milton S. Hershey Medical CenterHersheyPennsylvaniaUSA
| |
Collapse
|
7
|
Kandi V, Vadakedath S. Implant-Associated Infections: A Review of the Safety of Cardiac Implants. Cureus 2020; 12:e12267. [PMID: 33520485 PMCID: PMC7834584 DOI: 10.7759/cureus.12267] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2020] [Indexed: 12/12/2022] Open
Abstract
Cardiac implantations are among the most critical, and life-saving patient management procedures. Most cardiac implantations are performed to correct abnormalities in the conduction and the rhythm of the heart. Because the implants are intended for long-term use ranging from months to years, the failure of an implant is considered a major setback both in the patients as well as surgeons' perspectives. Implant failures can have multifactorial reasons, amongst which infectious causes need to be adequately addressed. This review attempts to evaluate the nature of implants, etiology, predisposing factors, infection control, and preventive strategies for cardiac implant-associated infections.
Collapse
Affiliation(s)
- Venkataramana Kandi
- Clinical Microbiology, Prathima Institute of Medical Sciences, Karimnagar, IND
| | | |
Collapse
|
8
|
Raza SA, Opie NL, Morokoff A, Sharma RP, Mitchell PJ, Oxley TJ. Endovascular Neuromodulation: Safety Profile and Future Directions. Front Neurol 2020; 11:351. [PMID: 32390937 PMCID: PMC7193719 DOI: 10.3389/fneur.2020.00351] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 04/08/2020] [Indexed: 12/16/2022] Open
Abstract
Endovascular neuromodulation is an emerging technology that represents a synthesis between interventional neurology and neural engineering. The prototypical endovascular neural interface is the StentrodeTM, a stent-electrode array which can be implanted into the superior sagittal sinus via percutaneous catheter venography, and transmits signals through a transvenous lead to a receiver located subcutaneously in the chest. Whilst the StentrodeTM has been conceptually validated in ovine models, questions remain about the long term viability and safety of this device in human recipients. Although technical precedence for venous sinus stenting already exists in the setting of idiopathic intracranial hypertension, long term implantation of a lead within the intracranial veins has never been previously achieved. Contrastingly, transvenous leads have been successfully employed for decades in the setting of implantable cardiac pacemakers and defibrillators. In the current absence of human data on the StentrodeTM, the literature on these structurally comparable devices provides valuable lessons that can be translated to the setting of endovascular neuromodulation. This review will explore this literature in order to understand the potential risks of the StentrodeTM and define avenues where further research and development are necessary in order to optimize this device for human application.
Collapse
Affiliation(s)
- Samad A Raza
- Department of Neurosurgery, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Nicholas L Opie
- Department of Medicine, Vascular Bionics Laboratory, Melbourne Brain Centre, The University of Melbourne, Melbourne, VIC, Australia
| | - Andrew Morokoff
- Department of Neurosurgery, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Rahul P Sharma
- Interventional Cardiology, Stanford Health Care, Palo Alto, CA, United States
| | - Peter J Mitchell
- Department of Radiology, The University of Melbourne & The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Thomas J Oxley
- Department of Medicine, Vascular Bionics Laboratory, Melbourne Brain Centre, The University of Melbourne, Melbourne, VIC, Australia.,Departments of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia.,Department of Neurosurgery, Mount Sinai Hospital, New York, NY, United States
| |
Collapse
|
9
|
Rodrigues ME, Gomes F, Rodrigues CF. Candida spp./Bacteria Mixed Biofilms. J Fungi (Basel) 2019; 6:jof6010005. [PMID: 31861858 PMCID: PMC7151131 DOI: 10.3390/jof6010005] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/13/2019] [Accepted: 12/14/2019] [Indexed: 12/21/2022] Open
Abstract
The ability to form biofilms is a common feature of microorganisms, such as bacteria or fungi. These consortiums can colonize a variety of surfaces, such as host tissues, dentures, and catheters, resulting in infections highly resistant to drugs, when compared with their planktonic counterparts. This refractory effect is particularly critical in polymicrobial biofilms involving both fungi and bacteria. This review emphasizes Candida spp.-bacteria biofilms, the epidemiology of this community, the challenges in the eradication of such biofilms, and the most relevant treatments.
Collapse
Affiliation(s)
- Maria Elisa Rodrigues
- CEB, Centre of Biological Engineering, LIBRO–Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho, 4710-057 Braga, Portugal; (M.E.R.); (F.G.)
| | - Fernanda Gomes
- CEB, Centre of Biological Engineering, LIBRO–Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho, 4710-057 Braga, Portugal; (M.E.R.); (F.G.)
| | - Célia F. Rodrigues
- LEPABE–Dep. of Chemical Engineering, Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal
- Correspondence:
| |
Collapse
|
10
|
Ma LL, Qiu Y, Song MN, Chen Y, Qu JX, Li BH, Zhao MJ, Liu XC. Clinical Trial Registration and Reporting: Drug Therapy and Prevention of Cardiac-Related Infections. Front Pharmacol 2019; 10:757. [PMID: 31333470 PMCID: PMC6624234 DOI: 10.3389/fphar.2019.00757] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 06/11/2019] [Indexed: 12/18/2022] Open
Abstract
Objective: Clinical trials are the source of evidence. ClinicalTrials.gov is valuable for analyzing current conditions. Until now, the state of drug interventions for heart infections is unknown. The purpose of this study was to comprehensively assess the characteristics of trials on cardiac-related infections and the status of drug interventions. Methods: The website ClinicalTrials.gov was used to obtain all registered clinical trials on drug interventions for cardiac-related infections as of February 16, 2019. All registration studies were collected, regardless of their recruitment status, research results, and research type. Registration information, results, and weblink-publications of those trials were analyzed. Results: A total of 45 eligible trials were evaluated and 86.7% of them began from or after 2008 while 91.1% of them adopted interventional study design. Of all trials, 35.6% were completed and 15.6% terminated. Besides, 62.2% of interventional clinical trials recruited more than 100 subjects. Meanwhile, 86.7% of the eligible trials included adult subjects only. Of intervention trials, 65.8% were in the third or fourth phase; 78.1% adopted randomized parallel assignment, containing two groups; 53.6% were masking, and 61.0% described treatment. Moreover, 41.5% of the trials were conducted in North America while 29.3% in Europe. Sponsors for 40.0% of the studies were from the industry. Furthermore, 48.9% of the trials mentioned information on monitoring committees, 24.4% have been published online, and 13.3% have uploaded their results. Drugs for treatments mainly contained antibiotics, among which glycopeptides, β-lactams, and lipopeptides were the most commonly studied ones in experimental group, with the former ones more common. Additionally, 16.2% of the trials evaluated new antimicrobials. Conclusions: Most clinical trials on cardiac-related infections registered at ClinicalTrials.gov were interventional randomized controlled trials (RCTs) for treatment. Most drugs focused in trials were old antibiotics, and few trials reported valid results. It is necessary to strengthen supervision over improvements in results, and to combine antibacterial activity with drug delivery regimens to achieve optimal clinical outcomes.
Collapse
Affiliation(s)
- Lin-Lu Ma
- Department of Cardiology, First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, China.,Center for Evidence-Based and Translational Medicine, Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Yang Qiu
- Cardiovascular Department, Kaifeng Central Hospital, Kaifeng, China
| | - Mei-Na Song
- Department of Nursing, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Yun Chen
- Department of Cardiology, First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, China.,Center for Evidence-Based and Translational Medicine, Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Jian-Xin Qu
- Department of Cardiology, First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, China.,Center for Evidence-Based and Translational Medicine, Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Bing-Hui Li
- Center for Evidence-Based Medicine, Institute of Evidence-Based Medicine and Knowledge Translation, Henan University, Kaifeng, China
| | - Ming-Juan Zhao
- Center for Evidence-Based Medicine, Institute of Evidence-Based Medicine and Knowledge Translation, Henan University, Kaifeng, China.,Department of Cardiology, The First Affiliated Hospital of Henan University, Kaifeng, China
| | - Xin-Can Liu
- Department of Cardiology, First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, China.,Center for Evidence-Based and Translational Medicine, Henan University of Traditional Chinese Medicine, Zhengzhou, China
| |
Collapse
|
11
|
Role of 18F-FDG PET/CT in infection of cardiovascular implantable electronic devices. Nucl Med Commun 2019; 40:555-564. [DOI: 10.1097/mnm.0000000000000995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
12
|
Altunbas G, Vuruskan E, Sucu M. Prevention of cardiac implantable electronic device infections: An unresolved issue. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:564. [PMID: 30657178 DOI: 10.1111/pace.13609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 12/26/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Gokhan Altunbas
- Department of Cardiology, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - Ertan Vuruskan
- Department of Cardiology, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - Murat Sucu
- Department of Cardiology, Gaziantep University School of Medicine, Gaziantep, Turkey
| |
Collapse
|
13
|
Zhu J, Yang Q, Pan J, Shi H, Jin B, Chen Q. Cardiac resynchronization therapy-defibrillator pocket infection caused by Mycobacterium fortuitum: a case report and review of the literature. BMC Cardiovasc Disord 2019; 19:53. [PMID: 30836955 PMCID: PMC6402086 DOI: 10.1186/s12872-019-1028-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 02/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With the rising utilization of cardiovascular implantable electronic devices (CIEDs), infections secondary to device implantation are increasingly encountered. Staphylococcus aureus and coagulase-negative staphylococci are usually the predominant causative organisms. A CIED infection due to non-tuberculous mycobacteria (NTM) is extremely rare. CASE PRESENTATION A 68-year-old man was admitted to our hospital with a history of pain and swelling at his cardiac resynchronization therapy-defibrillator (CRT-D) pocket site, for 4 days. The CRT-D had been implanted 2 weeks prior. The exudate smear was positive for acid-fast bacilli and culture results revealed rapidly growing nontuberculous mycobacteria (RGM). After an urgent removal of the device followed by 1 year of antibiotic treatment, the patient was completely cured. A new device was finally implanted, 3 years later. CONCLUSIONS Infections caused by nontuberculous mycobacteria following the implantation of cardiac devices are very rare. The typical manifestations of post-implantation CIED infections caused by RGMs include an early onset, with local redness, swelling, and spontaneous drainage. Systemic symptoms such as fever, chills, and fatigue are absent. Mycobacterium fortuitum is the most common species of RGM implicated in CIED infections, the manifestations of which usually appear within several weeks of the implantation procedure. An urgent removal of the device and appropriate antibiotic therapy are essential therapeutic measures. This is the first such reported case, in which the patient has been re-implanted with another device at the same site, after achieving a complete cure. We followed-up the patient for an additional 3 years and observed that the patient remained free of infection. Our case report shows that though an RGM infection is rare and difficult to treat, it can be completely cured. In addition, we demonstrated that it is subsequently possible to safely re-implant a CIED for the patient, at the same site.
Collapse
Affiliation(s)
- Jun Zhu
- Department of Cardiology, Huashan Hospital of Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Qingluan Yang
- Department of infectious Diseases, Huashan Hospital of Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Junjie Pan
- Department of Cardiology, Huashan Hospital of Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Haiming Shi
- Department of Cardiology, Huashan Hospital of Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Bo Jin
- Department of Cardiology, Huashan Hospital of Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China.
| | - Qiying Chen
- Department of Cardiology, Huashan Hospital of Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China.
| |
Collapse
|