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Mayer R, Desai K, Aguiar RSDT, McClure JJ, Kato N, Kalman C, Pilitsis JG. Evolution of Deep Brain Stimulation Techniques for Complication Mitigation. Oper Neurosurg (Hagerstown) 2024; 27:148-157. [PMID: 38315020 DOI: 10.1227/ons.0000000000001071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 12/07/2023] [Indexed: 02/07/2024] Open
Abstract
Complication mitigation in deep brain stimulation has been a topic matter of much discussion in the literature. In this article, we examine how neurosurgeons as individuals and as a field generated and adapted techniques to prevent infection, lead fracture/lead migration, and suboptimal outcomes in both the acute period and longitudinally. The authors performed a MEDLINE search inclusive of articles from 1987 to June 2023 including human studies written in English. Using the Rayyan platform, two reviewers (J.P. and R.M.) performed a title screen. Of the 776 articles, 252 were selected by title screen and 172 from abstract review for full-text evaluation. Ultimately, 124 publications were evaluated. We describe the initial complications and inefficiencies at the advent of deep brain stimulation and detail changes instituted by surgeons that reduced them. Furthermore, we discuss the trend in both undesired short-term and long-term outcomes with emphasis on how surgeons recognized and modified their practice to provide safer and better procedures. This scoping review adds to the literature as a guide to both new neurosurgeons and seasoned neurosurgeons alike to understand better what innovations have been trialed over time as we embark on novel targets and neuromodulatory technologies.
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Affiliation(s)
- Ryan Mayer
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton , Florida , USA
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Aydin A, Golian M, Klein A, Redpath C, Davis DR, Ramirez DF, Nair GM, Green M, Sadek M, Nery PB, Hansom SP, Corrales-Medina V, Wells GA, Birnie DH. Do barrier dressings reduce cardiac implantable device infection: Protocol for a randomized controlled trial (BARRIER-PROTECT). Heliyon 2023; 9:e22229. [PMID: 38046145 PMCID: PMC10686845 DOI: 10.1016/j.heliyon.2023.e22229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 11/03/2023] [Accepted: 11/07/2023] [Indexed: 12/05/2023] Open
Abstract
Background Cardiac implantable electronic device (CIED) procedures can be associated with serious complications, including infection with significant mortality and morbidity, necessitating removal of the device and prolonged hospitalization. One potential pathophysiological mechanism is pocket contamination at the time of device implantation. Therefore, steps taken to prevent contamination at this stage can potentially reduce CIED infections.The barrier dressing, an adhesive material applied to the skin, has the potential to reduce the colonization of the surgical site with host flora that can predispose to infection. There are a limited number of randomized prospective studies on barrier dressing use during various surgeries, but it has never been systematically studied in CIED implantation. Objectives Do Barrier Dressings Reduce Cardiac Implantable Device Infection? (BARRIER-PROTECT trial; NCT04591366) is a single-centre, prospective, double-armed, single-blinded, randomized controlled trial designed to evaluate the use of an intra-operative adhesive barrier dressing to reduce the risk of end-of-procedure pocket swab positivity. We hypothesize that adhesive draping during implant procedures will reduce the risk of contamination from the skin flora. Also, we aim to investigate if the end-of-procedure pocket swab culture positivity can be used as a potential surrogate marker of CIED infection. Methods and Design Patients undergoing a second or later procedure on the same device pocket (pulse generator change, lead/pocket revision or upgrade) will be enrolled. Eligible and consenting patients will be equally randomized to the use of barrier dressing or not using an automated web-based system. Patients, but not the operator, will be blinded to the arm. The person performing the pocket swabs will also be blinded. The primary endpoint is the end-of-procedure pocket swab culture positivity. The main secondary endpoint is the CIED infection rate. Discussion This is the first randomized controlled trial to assess the effectiveness of using a barrier adhesive draping on reducing the end-of-procedure pocket swab culture positivity. In this study, we are exploring a low-cost intervention that may significantly reduce CIED infection. Also, having a valid surrogate marker for CIED infection at the time of implant will facilitate design of future clinical trials.
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Affiliation(s)
- Alper Aydin
- Division of Cardiology, University of Ottawa Heart Institute, Canada
| | - Mehrdad Golian
- Division of Cardiology, University of Ottawa Heart Institute, Canada
| | - Andres Klein
- Division of Cardiology, University of Ottawa Heart Institute, Canada
| | - Calum Redpath
- Division of Cardiology, University of Ottawa Heart Institute, Canada
| | - Darryl R. Davis
- Division of Cardiology, University of Ottawa Heart Institute, Canada
| | - Daniel F. Ramirez
- Division of Cardiology, University of Ottawa Heart Institute, Canada
| | - Girish M. Nair
- Division of Cardiology, University of Ottawa Heart Institute, Canada
| | - Martin Green
- Division of Cardiology, University of Ottawa Heart Institute, Canada
| | - Mouhannad Sadek
- Division of Cardiology, University of Ottawa Heart Institute, Canada
| | - Pablo B. Nery
- Division of Cardiology, University of Ottawa Heart Institute, Canada
| | - Simon P. Hansom
- Division of Cardiology, University of Ottawa Heart Institute, Canada
| | - Vicente Corrales-Medina
- Division of Infectious Diseases, Department of Medicine, University of Ottawa, and The Ottawa Hospital, Canada
| | - George A. Wells
- Division of Cardiology, University of Ottawa Heart Institute, Canada
| | - David H. Birnie
- Division of Cardiology, University of Ottawa Heart Institute, Canada
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Nabuchi-Kawasaki M, Doi T, Mita T, Sasaki S, Hirokami M, Naraoka S, Yuda S. Infective endocarditis of transcatheter atrial septal occluder devices: A case report. J Cardiol Cases 2022; 26:336-340. [PMID: 36312778 PMCID: PMC9605895 DOI: 10.1016/j.jccase.2022.07.011] [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: 02/25/2022] [Revised: 06/26/2022] [Accepted: 07/04/2022] [Indexed: 11/01/2022] Open
Abstract
Learning objective
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Foster E, Furniss G, Dayer M. The effect of a standardised protocol for CIED insertion on complications and infection rates in a DGH. THE BRITISH JOURNAL OF CARDIOLOGY 2021; 28:27. [PMID: 35747453 PMCID: PMC8822513 DOI: 10.5837/bjc.2021.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Cardiac implantable electronic device (CIED)-related complications and infections typically lead to prolonged hospital stays and, very occasionally, death. A new CIED insertion protocol was implemented in a district general hospital. The primary objective of this study was to determine whether a significant reduction in complication and infection rates occurred after implementation of the new protocol. Medical records were reviewed for patients who had a CIED inserted in the two years pre- and post-protocol implementation, and any complications were identified in a one-year follow-up period. An increase in the complexity of the devices implanted after introduction of the protocol was observed. The number of complications was significantly reduced from 6.86% to 3.95% (p<0.0001). In the two years prior to protocol implementation, 14 of 871 (1.6%) patients suffered a CIED-related infection. In contrast, four of 683 (0.44%) patients suffered a CIEDrelated infection in the two years postimplementation. This was not statistically significant (p=0.093). In conclusion, implementing a standardised protocol for CIED insertion significantly reduced the rate of complications, and also reduced the rate of infection, but this was not statistically significant.
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Affiliation(s)
- Eliza Foster
- Cardiac Healthcare Scientist Bristol Heart Institute, Terrell Street, Bristol, BS2 8ED
| | - Guy Furniss
- Consultant Cardiologist Musgrove Park Hospital, Parkfield Drive, Taunton, TA1 5DA
| | - Mark Dayer
- Consultant Cardiologist Musgrove Park Hospital, Parkfield Drive, Taunton, TA1 5DA
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Development and Validation of a Semi-Automated Surveillance Algorithm for Cardiac Device Infections: Insights from the VA CART program. Sci Rep 2020; 10:5276. [PMID: 32210289 PMCID: PMC7093485 DOI: 10.1038/s41598-020-62083-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 03/09/2020] [Indexed: 11/08/2022] Open
Abstract
Procedure-related cardiac electronic implantable device (CIED) infections have high morbidity and mortality, highlighting the urgent need for infection prevention efforts to include electrophysiology procedures. We developed and validated a semi-automated algorithm based on structured electronic health records data to reliably identify CIED infections. A sample of CIED procedures entered into the Veterans' Health Administration Clinical Assessment Reporting and Tracking program from FY 2008-2015 was reviewed for the presence of CIED infection. This sample was then randomly divided into training (2/3) validation sets (1/3). The training set was used to develop a detection algorithm containing structured variables mapped from the clinical pathways of CIED infection. Performance of this algorithm was evaluated using the validation set. 2,107 unique CIED procedures from a cohort of 5,753 underwent manual review; 97 CIED infections (4.6%) were identified. Variables strongly associated with true infections included presence of a microbiology order, billing codes for surgical site infections and post-procedural antibiotic prescriptions. The combined algorithm to detect infection demonstrated high c-statistic (0.95; 95% confidence interval: 0.92-0.98), sensitivity (87.9%) and specificity (90.3%) in the validation data. Structured variables derived from clinical pathways can guide development of a semi-automated detection tool to surveil for CIED infection.
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Branch-Elliman W. A Roadmap for Reducing Cardiac Device Infections: a Review of Epidemiology, Pathogenesis, and Actionable Risk Factors to Guide the Development of an Infection Prevention Program for the Electrophysiology Laboratory. Curr Infect Dis Rep 2017; 19:34. [PMID: 28815459 DOI: 10.1007/s11908-017-0591-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Cardiovascular implantable electronic device (CIED) infections are highly morbid, common, and costly, and rates are increasing (Sohail et al. Arch Intern Med 171(20):1821-8 2011; Voigt et al. J Am Coll Cardiol 48(3):590-1 2006). Factors that contribute to the development of CIED infections include patient factors (comorbid conditions, self-care, microbiome), procedural details (repeat procedure, contamination during procedure, appropriate pre-procedural prep, and antimicrobial use), environmental and organizational factors (patient safety culture, facility barriers, such as lack of space to store essential supplies, quality of environmental cleaning), and microbial factors (type of organism, virulence of organism). Each of these can be specifically targeted with infection prevention interventions. RECENT FINDINGS Basic prevention practices, such as administration of systemic antimicrobials prior to incision and delaying the procedure in the setting of fever or elevated INR, are helpful for day-to-day prevention of cardiac device infections. Small single-center studies provide proof-of-concept that bundled prevention interventions can reduce infections, particularly in outbreak settings. However, data regarding which prevention strategies are the most important is limited as are data regarding the optimal prevention program for day-to-day prevention (Borer et al. Infect Control Hosp Epidemiol 25(6):492-7 2004; Ahsan et al. Europace 16(10):1482-9 2014). Evolution of infection prevention programs to include ambulatory and procedural areas is crucial as healthcare delivery is increasingly provided outside of hospitals and operating rooms. The focus on traditional operating rooms and inpatient care leaves the vast majority of healthcare delivery-including cardiac device implantations in the electrophysiology laboratory-uncovered.
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Affiliation(s)
- Westyn Branch-Elliman
- VA Boston Healthcare System, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
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LAKSHMANADOSS UMASHANKAR, NUANEZ BONITA, KUTINSKY ILANA, KHALID RIZWAN, HAINES DAVIDE, WONG WAISHUN. Incidence of Pocket Infection Postcardiac Device Implantation Using Antibiotic versus Saline Solution for Pocket Irrigation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:978-84. [DOI: 10.1111/pace.12920] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 07/11/2016] [Accepted: 07/18/2016] [Indexed: 11/28/2022]
Affiliation(s)
| | - BONITA NUANEZ
- Oakland University William Beaumont School of Medicine; Rochester Michigan
| | - ILANA KUTINSKY
- Department of Cardiology; Beaumont Health; Royal Oak Michigan
| | - RIZWAN KHALID
- Department of Cardiology; University of Rochester Medical Center; Rochester New York
| | - DAVID E HAINES
- Department of Cardiology; Beaumont Health; Royal Oak Michigan
| | - WAI SHUN WONG
- Department of Cardiology; Beaumont Health; Royal Oak Michigan
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Korantzopoulos P, Sideris S, Dilaveris P, Gatzoulis K, Goudevenos JA. Infection control in implantation of cardiac implantable electronic devices: current evidence, controversial points, and unresolved issues. Europace 2016; 18:473-478. [DOI: 10.1093/europace/euv260] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Cardiac Implantable Electronic Device Infection: From an Infection Prevention Perspective. Adv Prev Med 2015; 2015:357087. [PMID: 26550494 PMCID: PMC4621323 DOI: 10.1155/2015/357087] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 09/13/2015] [Indexed: 01/18/2023] Open
Abstract
A cardiac implantable electronic device (CIED) is indicated for patients with severely reduced ejection fraction or with life-threatening cardiac arrhythmias. Infection related to a CIED is one of the most feared complications of this life-saving device. The rate of CIED infection has been estimated to be between 2 and 25; though evidence shows that this rate continues to rise with increasing expenditure to the patient as well as healthcare systems. Multiple risk factors have been attributed to the increased rates of CIED infection and host comorbidities as well as procedure related risks. Infection prevention efforts are being developed as defined bundles in numerous hospitals around the country given the increased morbidity and mortality from CIED related infections. This paper aims at reviewing the various infection prevention measures employed at hospitals and also highlights the areas that have relatively less established evidence for efficacy.
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Chu XM, Yu H, Sun XX, An Y, Li B, Li XB. Identification of bacteriology and risk factor analysis of asymptomatic bacterial colonization in pacemaker replacement patients. PLoS One 2015; 10:e0119232. [PMID: 25768661 PMCID: PMC4358962 DOI: 10.1371/journal.pone.0119232] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 01/20/2015] [Indexed: 11/24/2022] Open
Abstract
Background Recent researches revealed that asymptomatic bacterial colonization on PMs might be ubiquitous and increase the risk of clinical PM infection. Early diagnosis of patients with asymptomatic bacterial colonization could provide opportunity for targeted preventive measures. Objective The present study explores the incidence of bacterial colonization of generator pockets in pacemaker replacement patients without signs of infection, and to analyze risk factors for asymptomatic bacterial colonization. Methods From June 2011 to December 2013, 118 patients underwent pacemaker replacement or upgrade. Identification of bacteria was carried out by bacterial culture and 16S rRNA sequencing. Clinical risk characteristics were analyzed. Results The total bacterial positive rate was 37.3% (44 cases), and the coagulase-negative Staphylococcus aureus detection rate was the highest. Twenty two (18.6%) patients had positive bacterial culture results, of which 50% had coagulase-negative staphylococcus. The bacterial DNA detection rate was 36.4 % (43 cases). Positive bacterial DNA results from pocket tissues and the surface of the devices were 22.0% and 29.7%, respectively. During follow-up (median, 27.0 months), three patients (6.8%, 3/44) became symptomatic with the same genus of microorganism, S. aureus (n=2) and S. epidermidis (n=1). Multivariable logistic regression analysis showed that history of bacterial infection, use of antibiotics, application of antiplatelet drugs, replacement frequency were independent risk factors for asymptomatic bacterial colonization. Conclusion There was a high incidence of asymptomatic bacterial colonization in pacemaker patients with independent risk factors. Bacterial culture combined genetic testing could improve the detection rate.
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Affiliation(s)
- Xian-Ming Chu
- Department of Cardiology, the Affiliated Hospital of Qingdao University, Qingdao, 266100, China
- * E-mail: (XC); (YA)
| | - Hua Yu
- The Affiliated Cardiovascular Hospital of Qingdao University, Qingdao, 266000, China
| | - Xue-Xia Sun
- Department of Cardiology, the Affiliated Hospital of Qingdao University, Qingdao, 266100, China
| | - Yi An
- Department of Cardiology, the Affiliated Hospital of Qingdao University, Qingdao, 266100, China
- * E-mail: (XC); (YA)
| | - Bing Li
- Department of Biology, Medical College of Qingdao University, Qingdao, 266021, China
| | - Xue-Bin Li
- Department of Cardiac Electrophysiology, Peking University People's Hospital, Beijing, 100044, China
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Genetic identification and risk factor analysis of asymptomatic bacterial colonization on cardiovascular implantable electronic devices. BIOMED RESEARCH INTERNATIONAL 2014; 2014:725163. [PMID: 25530969 PMCID: PMC4233659 DOI: 10.1155/2014/725163] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 08/17/2014] [Accepted: 08/19/2014] [Indexed: 11/18/2022]
Abstract
Asymptomatic bacterial colonization of cardiovascular implantable electronic devices (CIEDs) is widespread and increases the risk of clinical CIED infection. The aim of the study was to evaluate the incidence of bacterial colonization of generator pockets in patients without signs of infection and to analyze the relationship with clinical infection and risk factors. From June 2011 to December 2012, 78 patients underwent CIED replacement or upgrade. Exclusion criteria included a clinical diagnosis of CIED infection, bacteremia, or infective endocarditis. All patients were examined for evidence of bacterial 16S rDNA on the device and in the surrounding tissues. Infection cases were recorded during follow-up. The bacterial-positive rate was 38.5% (30 cases); the coagulase-negative Staphylococcus detection rate was the highest (9 cases, 11.5%). Positive bacterial DNA results were obtained from pocket tissue in 23.1% of patients (18 cases), and bacterial DNA was detected on the device in 29.5% of patients (23 cases). During follow-up (median 24.6 months), two patients (6.7%, 2/30) became symptomatic with the same species of microorganism, S. aureus and S. epidermidis. Multivariable logistic regression analysis found that the history of bacterial infection, use of antibiotics, application of antiplatelet drugs, replacement frequency, and renal insufficiency were independent risk factors for asymptomatic bacterial colonization.
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12
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Benito N, Pericas JM, Gurguí M, Mestres CA, Marco F, Moreno A, Horcajada JP, Miró JM. Health Care-Associated Infective Endocarditis: a Growing Entity that Can Be Prevented. Curr Infect Dis Rep 2014; 16:439. [PMID: 25230606 DOI: 10.1007/s11908-014-0439-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Infective endocarditis (IE) continues to be a serious disease with a poor prognosis and high mortality. Neither incidence rates nor mortality have decreased in recent decades. Because of this, it is important to prevent IE in patients at risk. In the past, prevention of IE has focused on antimicrobial prophylaxis, mainly for dental procedures. However, recent major changes in epidemiology, the most significant being the growing frequency and high mortality rate of health care-associated valve endocarditis (HAIE), mean that preventive strategies against IE must also change. Since intravascular catheters are the most common source of bacteremia among patients with HAIE, significant efforts must be made to minimize the risk of catheter-related bloodstream infections. Measures for preventing the infection of prosthetic valves and cardiac implantable devices at the time of implantation also need to be implemented.
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Affiliation(s)
- Natividad Benito
- Infectious Diseases Unit, Department of Internal Medicine. Hospital de la Santa Creu i Sant Pau-Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain,
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Marsch G, Mashaqi B, Burgwitz K, Bisdas T, Knigina L, Stiesch M, Haverich A, Kuehn C. Prevention of pacemaker infections with perioperative antimicrobial treatment: an in vitro study. Europace 2013; 16:604-11. [PMID: 23928734 DOI: 10.1093/europace/eut222] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS The antimicrobial treatment of pacemaker casings with antiseptics (povidone-iodine or octenidine dihydrochloride) or antibiotics (vancomycin, daptomycin, cefuroxime, Tazobac, or nebacetin) was analysed in vitro for its biocompatibility and efficacy in preventing the bacterial adhesion of Staphylococcus epidermidis, Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli to cardiac-implantable electrophysiological devices (CIEDs). METHODS AND RESULTS Titan platelets (0.4 cm²) cut from pacemaker casings were impregnated with seven different antimicrobial solutions: two antiseptics and five antibiotics. Subsequently, they were challenged with bacterial contamination by four test strains over a 24 h incubation period. Bacterial adherence was quantified using the colony-forming-unit method after cell recovery with sonication and examined with confocal laser scanning electron microscopy. Simultaneously, the biocompatibility of the antimicrobial impregnation was assessed using pre-treated titan platelets in a culture of human fibroblasts, skeletal myoblasts, and microvascular endothelial cells. After a 48 h incubation, cell vitality was measured using the 2-(2-methoxy-4-nitrophenyl)-3-(4-nitrophenyl)-5-(2,4-disulfophenyl)-2H/tetrazolium monosodium (WST-8) assay. The immersion of pacemaker casings in antiseptic or antibiotic solutions applies an antimicrobial coating that can significantly reduce bacterial adhesion. The studied impregnations differed in their antimicrobial efficacy and toxicity. CONCLUSION Compared with the two antiseptics and the other tested antibiotics, nebacetin showed the best ratio of efficacy to toxicity. Nebacetin showed good in vitro antibacterial activity against both Gram-positive and Gram-negative pathogens without impairing human cell vitality. It is a safe and effective candidate for CIED impregnation.
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Affiliation(s)
- Georg Marsch
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg Street 1, D-30625 Hannover, Germany
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Baddour LM, Cha YM, Wilson WR. Clinical practice. Infections of cardiovascular implantable electronic devices. N Engl J Med 2012; 367:842-9. [PMID: 22931318 DOI: 10.1056/nejmcp1107675] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Larry M Baddour
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
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Metais M, Hebrard A, Duparc A, Mondoly P, Delay M, Lepage B, Malavaud S. Cardiac implantable devices: Surveillance of surgical site infections and assessment of professional practices. Arch Cardiovasc Dis 2011; 104:325-31. [DOI: 10.1016/j.acvd.2011.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 02/22/2011] [Accepted: 02/23/2011] [Indexed: 11/28/2022]
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16
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Kleemann T, Becker T, Strauss M, Dyck N, Weisse U, Saggau W, Burkhardt U, Seidl K. Prevalence of bacterial colonization of generator pockets in implantable cardioverter defibrillator patients without signs of infection undergoing generator replacement or lead revision. Europace 2009; 12:58-63. [DOI: 10.1093/europace/eup334] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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Owens CD, Stoessel K. Surgical site infections: epidemiology, microbiology and prevention. J Hosp Infect 2009; 70 Suppl 2:3-10. [PMID: 19022115 DOI: 10.1016/s0195-6701(08)60017-1] [Citation(s) in RCA: 470] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Surgical site infections (SSIs) are defined as infections occurring up to 30 days after surgery (or up to one year after surgery in patients receiving implants) and affecting either the incision or deep tissue at the operation site. Despite improvements in prevention, SSIs remain a significant clinical problem as they are associated with substantial mortality and morbidity and impose severe demands on healthcare resources. The incidence of SSIs may be as high as 20%, depending on the surgical procedure, the surveillance criteria used, and the quality of data collection. In many SSIs, the responsible pathogens originate from the patient's endogenous flora. The causative pathogens depend on the type of surgery; the most commonly isolated organisms are Staphylococcus aureus, coagulase-negative staphylococci, Enterococcus spp. and Escherichia coli. Numerous patient-related and procedure-related factors influence the risk of SSI, and hence prevention requires a 'bundle' approach, with systematic attention to multiple risk factors, in order to reduce the risk of bacterial contamination and improve the patient's defences. The Centers for Disease Control and Prevention guidelines for the prevention of SSIs emphasise the importance of good patient preparation, aseptic practice, and attention to surgical technique; antimicrobial prophylaxis is also indicated in specific circumstances. Emerging technologies, such as microbial sealants, offer the ability to seal and immobilise skin flora for the duration of a surgical procedure; a strong case therefore exists for evaluating such technologies and implementing them into routine clinical practice as appropriate.
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Affiliation(s)
- C D Owens
- Kimberly-Clark Healthcare, Atlanta, GA, USA.
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Pichlmaier M, Marwitz V, Kuhn C, Niehaus M, Klein G, Bara C, Haverich A, Abraham WR. High prevalence of asymptomatic bacterial colonization of rhythm management devices. Europace 2008; 10:1067-72. [DOI: 10.1093/europace/eun191] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Interventions using foreign material to treat congenital heart disease in children increase the risk for infective endocarditis. Pediatr Infect Dis J 2008; 27:544-50. [PMID: 18449060 DOI: 10.1097/inf.0b013e3181690374] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Congenital heart disease (CHD) is a risk factor for infective endocarditis (IE). We aimed to assess the impact of cardiac interventions on the frequency and microbial profile of IE in children with CHD. METHODS Episodes of IE were analyzed in children aged < or =18 years with CHD between 1995 and 2005 with respect to cardiac surgery or catheter interventions with or without implantation of foreign material. RESULTS Diagnosis of IE was made in 14 (0.36%) of 3826 children with CHD including native IE in 6 and postinterventional IE in 8 patients. During the period 3029 cardiac interventions (1944 surgeries; 1085 catheters) were performed; foreign material was implanted in 1360 interventions (1139 surgeries; 221 catheters) including all 8 patients with postinterventional IE. Cardiac intervention by itself did not change the risk for IE compared with no intervention. The risk of IE after implantation of foreign material was higher than following intervention without implantation (odds ratio, 21.0; 95% confidence interval, 1.2-365; P < 0.05). Pacemaker implantation was associated with the highest risk for IE (odds ratio, 11.0; 95% confidence interval, 2.6-46.5; P < 0.001). Staphylococci were the most frequently isolated organisms in foreign material-associated IE. CONCLUSIONS Cardiac intervention in children with CHD does not increase the risk for IE. Postinterventional IE in children with CHD is strongly linked to implantation of foreign material, especially of pacemaker.
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Marschall J, Hopkins-Broyles D, Jones M, Fraser VJ, Warren DK. Case-control study of surgical site infections associated with pacemakers and implantable cardioverter-defibrillators. Infect Control Hosp Epidemiol 2007; 28:1299-304. [PMID: 17926282 DOI: 10.1086/520744] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2007] [Accepted: 06/05/2007] [Indexed: 11/04/2022]
Abstract
OBJECTIVE In 2000, the rate of surgical site infections (SSIs) associated with pacemaker and implantable cardioverter-defibrillator (ICD) procedures performed in the cardiothoracic operating rooms of hospital A was 16% (19 of 116 procedures resulted in infections). This study investigates risks for SSI associated with these procedures in the cardiothoracic operating room. DESIGN Unmatched 1 : 3 case-control study performed over a 12-month period among patients who had undergone implantation of a pacemaker and/or ICD. A standardized observation scrutinized infection control practices in the area where the procedures were performed. SETTING The cardiothoracic operating rooms of hospital A, which belongs to a hospital consortium in the midwestern United States. PATIENTS Patients with SSI were identified as case patients. Control patients were chosen from the group of uninfected patients who had procedures performed during the same period as case patients. RESULTS A total of 19 SSIs associated with pacemaker and ICD procedures were retrospectively identified among the patients who underwent procedures in these cardiothoracic operating rooms. Culture samples were obtained from 7 patients; 2 yielded coagulase-negative Staphylococcus on culture, 2 yielded Staphylococcus aureus, 1 yielded Serratia marcescens, and 2 showed no growth. In the case-control study, age, race, sex, diabetes mellitus, smoking history, timing of antibiotic therapy, and hair removal did not differ significantly between case patients and control patients. Case patients were more likely to have an abdominal device in place (odds ratio [OR], 5.5 [95% confidence interval {CI}, 1.6-19.3]; P=.006) and less likely to have received a new implant (OR 0.3 [95% CI, 0.1-0.8]; P=.02) or to have had new leads placed (OR, 0.2 [95% CI, 0.1-0.6]; P=.003). CONCLUSIONS Abdominal placement of implanted devices was associated with occurrence of an SSI after pacemaker and/or ICD procedures.
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Affiliation(s)
- Jonas Marschall
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO 63110, USA
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Lakkireddy D, Valasareddi S, Ryschon K, Basarkodu K, Rovang K, Mohiuddin SM, Hee T, Schweikert R, Tchou P, Wilkoff B, Natale A, Li H. The Impact of Povidone-Iodine Pocket Irrigation Use on Pacemaker and Defibrillator Infections. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2005; 28:789-94. [PMID: 16105006 DOI: 10.1111/j.1540-8159.2005.00173.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Infection is a devastating complication of permanent pacemakers (PMs) implantable cardioverter defibrillators (ICDs). Many implanting physicians commonly use povidone-iodine solution to irrigate the device pocket before implanting the device. We sought to assess if such a measure would alter the rate of infection. METHODS A total of 2,564 consecutive patients who received implantable PM or ICD devices between 1994 and 2002 were studied. Povidone-iodine was used for pocket irrigation in 53% and saline in 47%. A total of 18 (0.7%) patients developed pocket infections with 0.7% (10/1,359) in povidone-iodine (group I) and 0.6% (8/1,205) in saline (group II) pocket irrigation (p = ns). Groups I and II were studied for various clinical and demographic variables described in the results section. RESULTS There was no statistical difference in the baseline demographic and clinical characteristics between groups I and II, respectively. ICDs were most frequently infected than PMs (56% vs 44%). Most (83%) of the devices were dual chamber. Reopening of the pocket for either lead or generator replacement had a higher incidence of infection than new implants (61% vs 39%). There was no difference in the use of preimplantation antibiotic prophylaxis. Late (61%) and deep pocket infections (78%) were more common than early (39%) and superficial infections (22%). Blood cultures were positive in 67% and Staphylococcus aureus was the common most pathogen (50%). The mean duration of antibiotics use after the diagnosis of device infection was 35 +/- 23 days with 72% requiring device explantation. The device was reimplanted on the contralateral side in 56% cases. One patient in each group died due to device infection and related complications. No significant allergy to iodine was seen in either group. CONCLUSION Povidone-iodine irrigation of the subcutaneous pocket did not alter the rates of pocket infection after pacemaker/defibrillator implantation.
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