1
|
Raslan A, Alkhafaji NY, Mostofi A, Elhag A, Perera A, Kalaitzoglou D, Adindu K, Hulse N, Samuel M, Ashkan K. Antibiotic-impregnated envelopes reduce the rate of surgical site infection in deep brain stimulation pulse generators: a comparative study. Acta Neurochir (Wien) 2024; 166:318. [PMID: 39090257 DOI: 10.1007/s00701-024-06200-0] [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: 03/14/2024] [Accepted: 07/15/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND AND PURPOSE Deep brain stimulation (DBS) is a surgical procedure that has been used to treat a variety of neurological disorders including Parkinson's disease, essential tremor, and dystonia. While DBS is generally considered safe and effective, surgical site infections (SSIs) are a potential complication that can lead to significant morbidity and mortality. Our objective was to investigate the use of antibiotic-impregnated envelopes (AIEs) encasing implantable pulse generators (IPGs) to reduce the rate of infection at IPG sites and the costs. METHODS We conducted a retrospective analysis at a single center encompassing all procedures involving the placement of Implantable Pulse Generators (IPG), including both initial insertions and replacement surgeries. The study period spanned from January 2017 to May 2024. Starting in 2020, the routine utilization of AIE became standard practice at our institute for both primary DBS implantation and IPG replacements. Surgical techniques remained consistent, pre- and post-operative antibiotic protocols were standardized throughout the study period and all cases were undertaken by a single surgeon. RESULTS 178 patients were included and the overall incidence of IPG SSIs was found to be 1.7% (1 infection in 58 patients; 20 primary IPG/38 IPG replacements) among those who received an AIE compared to 5% (6 infections in 120 patients; 36 primary IPG/84 replacement IPG) in patients where no AIE was utilized. This resulted in an odds ratio for infection that was 2.9 times higher in the absence of AIE. The decrease in infection rates was observed in both primary and replacement IPG implants. Notably, over 80% of patients with IPG infection required surgical intervention. The use of AIE further resulted in significant cost savings. CONCLUSION To our knowledge, this is the largest series reporting the efficacy of Antibiotic impregnated envelope (AIE) in modifying infection rates associated with both initial and replacement Deep Brain Stimulation (DBS) Implantable Pulse Generators (IPGs). The implementation of AIEs led to a decrease in the occurrence of IPG-related infections, observed across both primary implantations and replacement surgeries, with associated economic benefits.
Collapse
Affiliation(s)
- Ahmed Raslan
- Department of Neurosurgery, Kings College Hospital, Denmark Hill, London, SE5 9RS, United Kingdom.
| | | | - Abteen Mostofi
- Department of Neurosurgery, Kings College Hospital, Denmark Hill, London, SE5 9RS, United Kingdom
| | - Ali Elhag
- Department of Neurosurgery, Kings College Hospital, Denmark Hill, London, SE5 9RS, United Kingdom
| | - Andrea Perera
- Department of Neurosurgery, Kings College Hospital, Denmark Hill, London, SE5 9RS, United Kingdom
- Department of Neurosciences, King's College London, London, United Kingdom
| | - Dimitrios Kalaitzoglou
- Department of Neurosurgery, Kings College Hospital, Denmark Hill, London, SE5 9RS, United Kingdom
| | - Kenneth Adindu
- Department of Neurosurgery, Kings College Hospital, Denmark Hill, London, SE5 9RS, United Kingdom
| | - Natasha Hulse
- Department of Neurosurgery, Kings College Hospital, Denmark Hill, London, SE5 9RS, United Kingdom
| | - Michael Samuel
- Department of Neurosciences, King's College London, London, United Kingdom
- Department of Neurology, King's College London, London, United Kingdom
| | - Keyoumars Ashkan
- Department of Neurosurgery, Kings College Hospital, Denmark Hill, London, SE5 9RS, United Kingdom
- Department of Neurosciences, King's College London, London, United Kingdom
| |
Collapse
|
2
|
Chesdachai S, Baddour LM, Sohail MR, Palraj BR, Madhavan M, Tabaja H, McGinnis MT, Fida M, Challener DW, DeSimone DC. Outcome of Corynebacterial Bloodstream Infection in Patients With Cardiac Implantable Electronic Devices: A Brief Report and Systematic Review. Open Forum Infect Dis 2024; 11:ofae441. [PMID: 39161858 PMCID: PMC11331626 DOI: 10.1093/ofid/ofae441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 07/27/2024] [Indexed: 08/21/2024] Open
Abstract
Cardiac implantable electronic device infection in the context of corynebacterial bloodstream infection (BSI) remains poorly understood. From 2012 to 2023 at Mayo Clinic, 4 of 12 patients with corynebacterial BSI had cardiac implantable electronic device infection: 1 patient was diagnosed during a relapsing BSI episode. Undefined source, persistent BSI, and the presence of a prosthetic cardiac valve were common characteristics.
Collapse
Affiliation(s)
- Supavit Chesdachai
- 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 Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - M Rizwan Sohail
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Bharath Raj Palraj
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Malini Madhavan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Hussam Tabaja
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Madiha Fida
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Douglas W Challener
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, 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 Medicine, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
3
|
Baddour LM, Esquer Garrigos Z, Rizwan Sohail M, Havers-Borgersen E, Krahn AD, Chu VH, Radke CS, Avari-Silva J, El-Chami MF, Miro JM, DeSimone DC. Update on Cardiovascular Implantable Electronic Device Infections and Their Prevention, Diagnosis, and Management: A Scientific Statement From the American Heart Association: Endorsed by the International Society for Cardiovascular Infectious Diseases. Circulation 2024; 149:e201-e216. [PMID: 38047353 DOI: 10.1161/cir.0000000000001187] [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] [Indexed: 12/05/2023]
Abstract
The American Heart Association sponsored the first iteration of a scientific statement that addressed all aspects of cardiovascular implantable electronic device infection in 2010. Major advances in the prevention, diagnosis, and management of these infections have occurred since then, necessitating a scientific statement update. An 11-member writing group was identified and included recognized experts in cardiology and infectious diseases, with a career focus on cardiovascular infections. The group initially met in October 2022 to develop a scientific statement that was drafted with front-line clinicians in mind and focused on providing updated clinical information to enhance outcomes of patients with cardiovascular implantable electronic device infection. The current scientific statement highlights recent advances in prevention, diagnosis, and management, and how they may be incorporated in the complex care of patients with cardiovascular implantable electronic device infection.
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Vonthein R, Baldauf B, Borov S, Lau EW, Giaccardi M, Cemin R, Assadian O, Chévalier P, Bode K, Bonnemeier H. The European TauroPace™ Registry. Methods Protoc 2023; 6:86. [PMID: 37736969 PMCID: PMC10514882 DOI: 10.3390/mps6050086] [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: 07/17/2023] [Revised: 09/08/2023] [Accepted: 09/12/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Cardiac implantable electronic device (CIED) placement comes with certain complications. CIED infection is a severe adverse event related to CIED placement. In randomised controlled trials, the preoperative intravenous administration of antibiotics and the adjunctive use of an antibiotic mesh envelope resulted in significant reduction in infections related to cardiac implantable electronic devices. The adjunctive use of taurolidine for this purpose is relatively novel and not considered in the guidelines. The required evidence may consist of a set of clinical studies. METHODS The European TauroPaceTM registry (ETPR) prospectively evaluates every consecutive invasive procedure involving any CIED with adjunct TauroPace™ use in the contributing centres. As the estimation of the infection rate needs to be defensible, only interventions registered prior to the procedure will be followed-up. The endpoint is a major cardiac implantable electronic device infection according to the novel CIED infection criteria (1). Secondary endpoints comprise all-cause mortality, complications, adverse events of all grades, and major CIED infections during all follow-up examinations. The follow-up times are three months, twelve months, and eventually 36 months, as acute, subacute, and long-term CIED infections are of interest. RESULTS As the rate of CIED infections is expected to be very low, this registry is a multicentre, international project that will run for several years. Several reports are planned. The analyses will be included in the case number calculations for future randomised controlled trials. CONCLUSIONS The ETPR will accumulate large case numbers to estimate small event rates more precisely; we intend to follow up on participants for years to reveal possible late effects.
Collapse
Affiliation(s)
- Reinhard Vonthein
- Institut für Medizinische Biometrie und Statistik, Universität zu Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Benito Baldauf
- Institute of Life Science, Hochschule Bremerhaven, An der Karlstadt 8, 27568 Bremerhaven, Germany
- Medical Faculty, Christian-Albrechts University, Christian-Albrechts-Platz 4, 24118 Kiel, Germany
| | - Stefan Borov
- Medical Faculty, Christian-Albrechts University, Christian-Albrechts-Platz 4, 24118 Kiel, Germany
- Department of Cardiology, Klinikum Freising, Alois-Steinecker-Straße 18, 85354 Freising, Germany
| | - Ernest W. Lau
- Department of Cardiology, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, UK
| | - Marzia Giaccardi
- Department of Cardiology, Ospedale Santa Maria Annunziata, Ponte a Niccheri, 50012 Florence, Italy
| | - Roberto Cemin
- Department of Cardiology, Ospedale Regionale San Maurizio, Bolzano, Via Lorenz Böhler 5, 39100 Bolzano, Italy
| | - Ojan Assadian
- Regional Hospital Wiener Neustadt, Wiener Neustadt 2700, Austria
- Institute for Skin Integrity and Infection Prevention, School of Human and Health Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK
| | - Philippe Chévalier
- Department of Cardiology, Hôpital Louis Pradel, 59 Bd Pinel, 69500 Bron, France
| | - Kerstin Bode
- Department of Electropyhsiology, Herzzentrum Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany
| | - Hendrik Bonnemeier
- Institute of Life Science, Hochschule Bremerhaven, An der Karlstadt 8, 27568 Bremerhaven, Germany
- Medical Faculty, Christian-Albrechts University, Christian-Albrechts-Platz 4, 24118 Kiel, Germany
- Department of Cardiology, Helios Klinikum Cuxhaven, Altenwalder Ch 10, 27474 Cuxhaven, Germany
- Department of Cardiology, Helios Klinikum Wesermarsch, Mildred-Scheel-Straße 1, 26954 Nordenham, Germany
| |
Collapse
|
6
|
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.
| |
Collapse
|
7
|
Love CJ, Hanna I, Thomas G, Greenspon AJ, Christie M, Goodman J, Christopherson M, Balaji V, Skulsky S, Sanders M, Bauer C, Schindeldecker W, Kirchhof N, Sohail MR. Preclinical evaluation of a third-generation absorbable antibacterial envelope. Heart Rhythm 2023; 20:737-743. [PMID: 36693614 DOI: 10.1016/j.hrthm.2023.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/03/2023] [Accepted: 01/12/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND The TYRX (Medtronic) absorbable antibacterial envelope has been shown to stabilize implantable cardiac devices and reduce infection. A third-generation envelope was developed to reduce surface roughness with a redesigned multifilament mesh and enhanced form factor but identical polymer coating and antibiotic concentrations as the currently available second-generation envelope. OBJECTIVE The purpose of this study was to compare drug elution, bacterial challenge efficacy, stabilization, and absorption of second- vs third-generation envelopes. METHODS Antibiotic elution was assessed in vitro and in vivo. For efficacy against gram-positive/gram-negative bacteria, 40 rabbits underwent device insertions with or without third-generation envelopes. For stabilization (migration, rotation), 5 sheep were implanted with 6 devices each in second- or third-generation envelopes. Prespecified acceptance criteria were <83-mm migration and <90° rotation. Absorption was assessed via gross pathology. RESULTS Elution curves were equivalent (similarity factors ≥50 per Food and Drug Administration guidance). Third-generation envelopes eluted antibiotics above minimal inhibitory concentration (MIC) in vivo at 2 hours postimplant through 7 days, consistent with second-generation envelopes. Bacterial challenge showed reductions (P <.05) in infection with second- and third-generation envelopes. Device migration was 5.5 ± 3.5 mm (third-generation) vs 9. 9 ±7.9 mm (second-generation) (P <.05). Device rotation was 18.9° ± 11.4° (third-generation) vs 17.6° ± 15.1° (second-generation) and did not differ (P = .79). Gross pathology confirmed the absence of luminal mesh remainders and no differences in peridevice fibrosis at 9 or 12 weeks. CONCLUSION The third-generation TYRX absorbable antibacterial envelope demonstrated equivalent preclinical performance to the second-generation envelope. Antibiotic elution curves were similar, elution was above MIC for 7 days, infections were reduced compared to no envelope, and acceptance criteria for migration, rotation, and absorption were met.
Collapse
Affiliation(s)
- Charles J Love
- Department of Medicine, Johns Hopkins Medicine, Baltimore, Maryland.
| | - Ibrahim Hanna
- Cardiac Electrophysiology, Brookwood Baptist Health, Birmingham, Alabama
| | - George Thomas
- Division of Cardiology, Weill Cornell Medicine, New York, New York
| | - Arnold J Greenspon
- Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | | | | | | | | | | | | | | | | | | | - M Rizwan Sohail
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| |
Collapse
|
8
|
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
|
9
|
Yu CM, Yu CM, Yao WT, Lee YH, Liao FC, Chien CY, Chang SH, Liao HW, Chen YF, Huang WC, Tung KY, Tsai MF. Safety and Efficacy of Submuscular Implantation With Resterilized Cardiac Implantable Electronic Device in Patients With Device Infection: A Retrospective Observational Study in Taiwan. Open Forum Infect Dis 2022; 9:ofac100. [PMID: 35415195 PMCID: PMC8995070 DOI: 10.1093/ofid/ofac100] [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: 11/18/2021] [Accepted: 03/01/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Reuse of cardiac implantable electronic devices (CIEDs) can reduce the cost of using these expensive devices. However, whether resterilized CIEDs will increase the risk of reinfection in patients with previous device infection remains unknown. The aim of the present study is to compare the reinfection rates in patients who had initial CIED infection and underwent reimplantation of resterilized CIEDs or new devices.
Methods
Data from patients with initial CIED infection who received debridement of the infected pocket and underwent reimplantation of new or resterilized CIEDs at MacKay Memorial Hospital, Taipei, Taiwan, between January 2014 and June 2019 were retrospectively analyzed. Patient characteristics, relapse rates of infection, and potential contributing factors to the infection risk were examined.
Results
Twenty-seven patients with initial CIED infection and reimplanted new CIEDs (n = 11) or resterilized CIEDs (n = 16) were included. During the 2-year follow-up, there were 1 (9.1%) and 2 (12.5%) infection relapses in the new and resterilized CIED groups, respectively. No relapse occurred for either group if the lead was completely removed or cut short. The median duration between debridement and device reimplantation in patients with infection relapse vs patients without relapse was 97 vs 4.5 days for all included patients, and 97 vs 2 days and 50.5 vs 5.5 days for the new and resterilized CIED groups, respectively.
Conclusions
Subpectoral reimplanting of resterilized CIEDs in patients with previous device infection is safe and efficacious. With delicate debridement and complete extraction of the leads, the CIED pocket infection relapse risk can be greatly decreased.
Collapse
Affiliation(s)
- Chia-Meng Yu
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei City, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei, Taiwan
| | - Chieh-Ming Yu
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei City, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei, Taiwan
| | - Wen-Teng Yao
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei City, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei, Taiwan
| | - Ying-Hsiang Lee
- Department of Medicine, MacKay Medical College, New Taipei, Taiwan
- Cardiovascular Center, MacKay Memorial Hospital, Taipei City, Taiwan
| | - Feng-Ching Liao
- Department of Medicine, MacKay Medical College, New Taipei, Taiwan
- Cardiovascular Center, MacKay Memorial Hospital, Taipei City, Taiwan
| | - Chih-Yin Chien
- Department of Nursing, MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
- National Taipei University of Nursing and Healthy Sciences, Taipei, Taiwan
| | - Sheng-Hsiung Chang
- Department of Medicine, MacKay Medical College, New Taipei, Taiwan
- Cardiovascular Center, MacKay Memorial Hospital, Taipei City, Taiwan
| | - Hung-Wei Liao
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei City, Taiwan
| | - Yu-Fan Chen
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei City, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei, Taiwan
| | - Wen-Chen Huang
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei City, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei, Taiwan
| | - Kwang-Yi Tung
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei City, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei, Taiwan
| | - Ming-Feng Tsai
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei City, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei, Taiwan
| |
Collapse
|
10
|
Role of Implantable Drug Delivery Devices with Dual Platform Capabilities in the Prevention and Treatment of Bacterial Osteomyelitis. Bioengineering (Basel) 2022; 9:bioengineering9020065. [PMID: 35200418 PMCID: PMC8869141 DOI: 10.3390/bioengineering9020065] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 11/26/2022] Open
Abstract
As medicine advances and physicians are able to provide patients with innovative solutions, including placement of temporary or permanent medical devices that drastically improve quality of life of the patient, there is the persistent, recurring problem of chronic bacterial infection, including osteomyelitis. Osteomyelitis can manifest as a result of traumatic or contaminated wounds or implant-associated infections. This bacterial infection can persist as a result of inadequate treatment regimens or the presence of biofilm on implanted medical devices. One strategy to mitigate these concerns is the use of implantable medical devices that simultaneously act as local drug delivery devices (DDDs). This classification of device has the potential to prevent or aid in clearing chronic bacterial infection by delivering effective doses of antibiotics to the area of interest and can be engineered to simultaneously aid in tissue regeneration. This review will provide a background on bacterial infection and current therapies as well as current and prospective implantable DDDs, with a particular emphasis on local DDDs to combat bacterial osteomyelitis.
Collapse
|
11
|
Boriani G, Proietti M, Bertini M, Diemberger I, Palmisano P, Baccarini S, Biscione F, Bottoni N, Ciccaglioni A, Dal Monte A, Ferrari FA, Iacopino S, Piacenti M, Porcelli D, Sangiorgio S, Santini L, Malagù M, Stabile G, Imberti JF, Caruso D, Zoni-Berisso M, De Ponti R, Ricci RP. Incidence and Predictors of Infections and All-Cause Death in Patients with Cardiac Implantable Electronic Devices: The Italian Nationwide RI-AIAC Registry. J Pers Med 2022; 12:91. [PMID: 35055406 PMCID: PMC8780465 DOI: 10.3390/jpm12010091] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The incidence of infections associated with cardiac implantable electronic devices (CIEDs) and patient outcomes are not fully known. AIM To provide a contemporary assessment of the risk of CIEDs infection and associated clinical outcomes. METHODS In Italy, 18 centres enrolled all consecutive patients undergoing a CIED procedure and entered a 12-months follow-up. CIED infections, as well as a composite clinical event of infection or all-cause death were recorded. RESULTS A total of 2675 patients (64.3% male, age 78 (70-84)) were enrolled. During follow up 28 (1.1%) CIED infections and 132 (5%) deaths, with 152 (5.7%) composite clinical events were observed. At a multivariate analysis, the type of procedure (revision/upgrading/reimplantation) (OR: 4.08, 95% CI: 1.38-12.08) and diabetes (OR: 2.22, 95% CI: 1.02-4.84) were found as main clinical factors associated to CIED infection. Both the PADIT score and the RI-AIAC Infection score were significantly associated with CIED infections, with the RI-AIAC infection score showing the strongest association (OR: 2.38, 95% CI: 1.60-3.55 for each point), with a c-index = 0.64 (0.52-0.75), p = 0.015. Regarding the occurrence of composite clinical events, the Kolek score, the Shariff score and the RI-AIAC Event score all predicted the outcome, with an AUC for the RI-AIAC Event score equal to 0.67 (0.63-0.71) p < 0.001. CONCLUSIONS In this Italian nationwide cohort of patients, while the incidence of CIED infections was substantially low, the rate of the composite clinical outcome of infection or all-cause death was quite high and associated with several clinical factors depicting a more impaired clinical status.
Collapse
Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy;
| | - Marco Proietti
- Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, 20138 Milan, Italy;
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool L7 3FA, UK
| | - Matteo Bertini
- Cardiological Center, University of Ferrara, 44124 Ferrara, Italy; (M.B.); (M.M.)
| | - Igor Diemberger
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, University of Bologna, Policlinico S. Orsola-Malpighi, 40138 Bologna, Italy;
| | - Pietro Palmisano
- Cardiology Unit, ‘Card. Giovanni Panico’ Hospital, 73039 Tricase, Italy;
| | - Stefano Baccarini
- Cardiology Unit, Emergency Department, Fidenza Hospital, 43036 Fidenza, Italy;
| | | | | | - Antonio Ciccaglioni
- Department of Cardiovascular Sciences, Sapienza-University of Rome, 00161 Rome, Italy;
| | | | | | - Saverio Iacopino
- Electrophysiology Unit, Maria Cecilia Hospital, 48033 Cotignola, Italy;
| | | | - Daniele Porcelli
- Arrhythmology Unit, Cardiology Department, S. Giovanni Calibita Fatebenefratelli Hospital, 00186 Rome, Italy;
| | | | - Luca Santini
- Department of Cardiology, Ospedale GB Grassi, 00122 Ostia, Italy;
| | - Michele Malagù
- Cardiological Center, University of Ferrara, 44124 Ferrara, Italy; (M.B.); (M.M.)
| | - Giuseppe Stabile
- Department of Cardiology, Clinica Montevergine, 83013 Mercogliano, Italy;
| | - Jacopo Francesco Imberti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy;
| | - Davide Caruso
- Padre Antero Micone Hospital, ASL 3 “Genovese”, 16153 Genova, Italy; (D.C.); (M.Z.-B.)
| | - Massimo Zoni-Berisso
- Padre Antero Micone Hospital, ASL 3 “Genovese”, 16153 Genova, Italy; (D.C.); (M.Z.-B.)
| | - Roberto De Ponti
- Cardiovascular Department, Circolo Hospital, University of Insubria, 21100 Varese, Italy;
| | | | | |
Collapse
|
12
|
Elzein F, Alsufyani E, Al Hebaishi Y, Mosaad M, Alqurashi M, Al Fagih A. Brucella cardiac implantable electronic device infection: A single-center case series. Ann Med Surg (Lond) 2021; 68:102568. [PMID: 34367635 PMCID: PMC8326340 DOI: 10.1016/j.amsu.2021.102568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/13/2021] [Accepted: 07/13/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Cardiac implantable electronic devices (CIEDs), including implantable cardiac defibrillators, pacemakers, and cardiac resynchronization therapy devices, are lifesaving. However, device infections can lead to morbidity and mortality. The aim of this study was to describe the outcome of Brucella CIED infections treated at our center, and to identify risk factors for Brucella infection in patients with CIEDs. Study Settings: Single-center study, Prince Sultan Military Medical City, Riyadh, KSA. METHODS This case series included all Brucella-related CIED infections treated at a tertiary care center between 2009 and 2020. Data on patient demographics, clinical manifestations, predisposing factors, microbiology, treatment regimens, and outcomes were reviewed. RESULTS Fifteen patients met the Brucella CIED infection criteria. The mean age was 62.2 years, and 80% were males. Common comorbidities included hypertension (73%), diabetes mellitus (67%), ischemic heart disease (47%), and chronic kidney disease (60%). The mean time to infection following the device implantation was 4.8 years (range: 5 months to 13 years). Fever was detected in 53% of patients, device site swelling in 47%, purulent discharge in 33%, and pain in 27%. The blood culture and serology results were positive in 73% and 80% of patients, respectively. All patients were treated with antibiotics, and the infected device was removed. Seven (46.6%) patients underwent reimplantation with a new device. One patient with dual Brucella and methicillin-sensitive Staphylococcus aureus infection died, and the other 14 patients recovered, with no recurrent infections reported to date. CONCLUSION Brucella should be considered in CIED infections, particularly in endemic areas. Proper treatment and device removal are essential for good outcomes.
Collapse
Affiliation(s)
- Fatehi Elzein
- Infectious Diseases Unit, Prince Sultan Military Medical City, P.O. Box 7897, Riyadh, 11159, Saudi Arabia
| | - Eid Alsufyani
- Infectious Diseases Unit, Prince Sultan Military Medical City, P.O. Box 7897, Riyadh, 11159, Saudi Arabia
| | | | | | - Moayad Alqurashi
- Infectious Diseases Unit, Prince Sultan Military Medical City, P.O. Box 7897, Riyadh, 11159, Saudi Arabia
| | | |
Collapse
|
13
|
Tarakji KG, Korantzopoulos P, Philippon F, Biffi M, Mittal S, Poole JE, Kennergren C, Lexcen DR, Lande JD, Seshadri S, Wilkoff BL. Infectious consequences of hematoma from cardiac implantable electronic device procedures and the role of the antibiotic envelope: A WRAP-IT trial analysis. Heart Rhythm 2021; 18:2080-2086. [PMID: 34280568 DOI: 10.1016/j.hrthm.2021.07.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/07/2021] [Accepted: 07/11/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hematoma is a complication of cardiac implantable electronic device (CIED) procedures and may lead to device infection. The TYRX antibacterial envelope reduced major CIED infection by 40% in the randomized WRAP-IT (World-wide Randomized Antibiotic Envelope Infection Prevention Trial) study, but its effectiveness in the presence of hematoma is not well understood. OBJECTIVE The purpose of this study was to evaluate the incidence and infectious consequences of hematoma and the association between envelope use, hematomas, and major CIED infection among WRAP-IT patients. METHODS All 6800 study patients were included in this analysis (control 3429; envelope 3371). Hematomas occurring within 30 days postprocedure (acute) were characterized and grouped by study treatment and evaluated for subsequent infection risk. Data were analyzed using Cox proportional hazard regression modeling. RESULTS Acute hematoma incidence was 2.2% at 30 days, with no significant difference between treatment groups (envelope vs control hazard ratio [HR] 1.15; 95% confidence interval [CI] 0.84-1.58; P = .39). Through all follow-up, the risk of major infection was significantly higher among control patients with hematoma vs those without (13.1% vs 1.6%; HR 11.3; 95% CI 5.5-23.2; P <.001). The risk of major infection was significantly lower in the envelope vs control patients with hematoma (2.5% vs 13.1%; HR 0.18; 95% CI 0.04-0.85; P = .03). CONCLUSION The risk of hematoma was 2.2% among WRAP-IT patients. Among control patients, hematoma carried a >11-fold risk of developing a major CIED infection. This risk was significantly mitigated with antibacterial envelope use, with an 82% reduction in major CIED infection among envelope patients who developed hematoma compared to control.
Collapse
Affiliation(s)
- Khaldoun G Tarakji
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland Ohio.
| | | | - Francois Philippon
- Electrophysiology Division, Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), Québec, Canada
| | - Mauro Biffi
- Institute of Cardiology, University of Bologna, Policlinico Sant' Orsola, Malpighi, Italy
| | - Suneet Mittal
- Department of Cardiology, Valley Health System, Ridgewood, New Jersey
| | - Jeanne E Poole
- Division of Cardiology, University of Washington School of Medicine, Seattle, Washington
| | - Charles Kennergren
- First Department of Cardiology, University Hospital of Ioannina, Ioannina, Greece; Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Göteborg, Sweden
| | | | | | | | - Bruce L Wilkoff
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland Ohio
| |
Collapse
|