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Azad MA, Patel R. Practical Guidance for Clinical Microbiology Laboratories: Microbiologic diagnosis of implant-associated infections. Clin Microbiol Rev 2024; 37:e0010423. [PMID: 38506553 PMCID: PMC11237642 DOI: 10.1128/cmr.00104-23] [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] [Indexed: 03/21/2024] Open
Abstract
SUMMARYImplant-associated infections (IAIs) pose serious threats to patients and can be associated with significant morbidity and mortality. These infections may be difficult to diagnose due, in part, to biofilm formation on device surfaces, and because even when microbes are found, their clinical significance may be unclear. Despite recent advances in laboratory testing, IAIs remain a diagnostic challenge. From a therapeutic standpoint, many IAIs currently require device removal and prolonged courses of antimicrobial therapy to effect a cure. Therefore, making an accurate diagnosis, defining both the presence of infection and the involved microorganisms, is paramount. The sensitivity of standard microbial culture for IAI diagnosis varies depending on the type of IAI, the specimen analyzed, and the culture technique(s) used. Although IAI-specific culture-based diagnostics have been described, the challenge of culture-negative IAIs remains. Given this, molecular assays, including both nucleic acid amplification tests and next-generation sequencing-based assays, have been used. In this review, an overview of these challenging infections is presented, as well as an approach to their diagnosis from a microbiologic perspective.
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Affiliation(s)
- Marisa Ann Azad
- Division of Infectious Diseases, Department of Medicine, The Ottawa Hospital, Ottawa, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Robin Patel
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
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Alam F, Ashfaq Ahmed M, Jalal AH, Siddiquee I, Adury RZ, Hossain GMM, Pala N. Recent Progress and Challenges of Implantable Biodegradable Biosensors. MICROMACHINES 2024; 15:475. [PMID: 38675286 PMCID: PMC11051912 DOI: 10.3390/mi15040475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024]
Abstract
Implantable biosensors have evolved to the cutting-edge technology of personalized health care and provide promise for future directions in precision medicine. This is the reason why these devices stand to revolutionize our approach to health and disease management and offer insights into our bodily functions in ways that have never been possible before. This review article tries to delve into the important developments, new materials, and multifarious applications of these biosensors, along with a frank discussion on the challenges that the devices will face in their clinical deployment. In addition, techniques that have been employed for the improvement of the sensitivity and specificity of the biosensors alike are focused on in this article, like new biomarkers and advanced computational and data communicational models. A significant challenge of miniaturized in situ implants is that they need to be removed after serving their purpose. Surgical expulsion provokes discomfort to patients, potentially leading to post-operative complications. Therefore, the biodegradability of implants is an alternative method for removal through natural biological processes. This includes biocompatible materials to develop sensors that remain in the body over longer periods with a much-reduced immune response and better device longevity. However, the biodegradability of implantable sensors is still in its infancy compared to conventional non-biodegradable ones. Sensor design, morphology, fabrication, power, electronics, and data transmission all play a pivotal role in developing medically approved implantable biodegradable biosensors. Advanced material science and nanotechnology extended the capacity of different research groups to implement novel courses of action to design implantable and biodegradable sensor components. But the actualization of such potential for the transformative nature of the health sector, in the first place, will have to surmount the challenges related to biofouling, managing power, guaranteeing data security, and meeting today's rules and regulations. Solving these problems will, therefore, not only enhance the performance and reliability of implantable biodegradable biosensors but also facilitate the translation of laboratory development into clinics, serving patients worldwide in their better disease management and personalized therapeutic interventions.
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Affiliation(s)
- Fahmida Alam
- Department of Electrical and Computer Engineering, University of Texas Rio Grande Valley, Edinburg, TX 78539, USA; (A.H.J.); (G.M.M.H.)
| | | | - Ahmed Hasnain Jalal
- Department of Electrical and Computer Engineering, University of Texas Rio Grande Valley, Edinburg, TX 78539, USA; (A.H.J.); (G.M.M.H.)
| | - Ishrak Siddiquee
- Institute of Microsystems Technology, University of South-Eastern Norway, Horten, 3184 Vestfold, Norway;
| | - Rabeya Zinnat Adury
- Department of Applied Physiology and Kinesiology, College of Health and Human Performance, University of Florida, Gainesville, FL 32611, USA;
| | - G M Mehedi Hossain
- Department of Electrical and Computer Engineering, University of Texas Rio Grande Valley, Edinburg, TX 78539, USA; (A.H.J.); (G.M.M.H.)
| | - Nezih Pala
- Department of Electrical and Computer Engineering, Florida International University, Miami, FL 33174, 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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Chesdachai S, DeSimone DC, Baddour LM. Risk of Cardiac Implantable Electronic Device Infection in Patients with Bloodstream Infection: Microbiologic Effect in the Era of Positron Emission Tomography-Computed Tomography. Curr Cardiol Rep 2023; 25:781-793. [PMID: 37351825 DOI: 10.1007/s11886-023-01900-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/01/2023] [Indexed: 06/24/2023]
Abstract
PURPOSE OF REVIEW Bloodstream infection (BSI) in patients with cardiac implantable electronic devices (CIEDs) is common and can prompt challenges in defining optimal management. We provide a contemporary narrative review of this topic and propose a pathogen-dependent clinical approach to patient management. RECENT FINDINGS BSI due to staphylococci, viridans group streptococci, and enterococci is associated with an increased risk of underlying CIED infection, while the risk of CIED infection due to other organisms is poorly defined. There is growing evidence that positron emission tomography-computed tomography may be helpful in some patients with BSI and underlying CIED. Twenty studies were included to examine the impact of microbiologic findings on the risk of CIED infection among patients with BSI. Diagnosis of CIED infection in patients with BSI without pocket findings is often difficult, necessitating the use of novel diagnostic tools to help guide the clinician in subsequent patient management.
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Affiliation(s)
- Supavit Chesdachai
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Daniel C DeSimone
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA
| | - Larry M Baddour
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA
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Šačić D, Petrović O, Zamaklar-Trifunović D, Ivanović B. Cardiac pacemaker-related endocarditis complicated with pulmonary embolism: Case report. Front Cardiovasc Med 2023; 10:1191194. [PMID: 37396580 PMCID: PMC10313500 DOI: 10.3389/fcvm.2023.1191194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/29/2023] [Indexed: 07/04/2023] Open
Abstract
Cardiac device-related endocarditis as a device-therapy complication is a growing problem due to higher life expectancy and the increasing number of abandoned leads and subclinical symptoms. We reported a case of a 47-year-old woman with an implanted pacemaker who was admitted to the clinic for cardiology due to the right-sided device-related infective endocarditis of the pacemaker leads with vegetations, predominantly in the right atrium and right ventricle and complicated by pulmonary embolism. Several years after pacemaker implantation, she was diagnosed with systemic lupus erythematosus and started immunosuppressive therapy. The patient was treated with prolonged intravenous antibiotic therapy. The atrial and ventricular lead was extirpated, and the posterior leaflet of the tricuspid valve was shaved.
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Affiliation(s)
- Dalila Šačić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Olga Petrović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Danijela Zamaklar-Trifunović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Branislava Ivanović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
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Tascini C, Giuliano S, Attanasio V, Segreti L, Ripoli A, Sbrana F, Severino S, Sordelli C, Weisz SH, Zanus-Fortes A, Leanza GM, Carannante N, Di Cori A, Bongiorni MG, Zucchelli G, De Vivo S. Safety and Efficacy of a Single Procedure of Extraction and Reimplantation of Infected Cardiovascular Implantable Electronic Device (CIED) in Comparison with Deferral Timing: An Observational Retrospective Multicentric Study. Antibiotics (Basel) 2023; 12:1001. [PMID: 37370320 DOI: 10.3390/antibiotics12061001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023] Open
Abstract
(1) Background: Infections are among the most frequent and life-threatening complications of cardiovascular implantable electronic device (CIED) implantation. The aim of this study is to compare the outcome and safety of a single-procedure device extraction and contralateral implantation versus the standard-of-care (SoC) two-stage replacement for infected CIEDs. (2) Methods: We retrospectively included 66 patients with CIED infections who were treated at two Italian hospitals. Of the 66 patients enrolled in the study, 27 underwent a single procedure, whereas 39 received SoC treatment. All patients were followed up for 12 months after the procedure. (3) Results: Considering those lost to follow-up, there were no differences in the mortality rates between the two cohorts, with survival rates of 81.5% in the single-procedure group and 84.6% in the SoC group (p = 0.075). (4) Conclusions: Single-procedure reimplantation associated with an active antibiofilm therapy may be a feasible and effective therapeutic option in CIED-dependent and frail patients. Further studies are warranted to define the best treatment regimen and strategies to select patients suitable for the single-procedure reimplantation.
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Affiliation(s)
- Carlo Tascini
- Infectious Diseases Clinic, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
- Infectious Diseases Clinic, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), 33100 Udine, Italy
| | - Simone Giuliano
- Infectious Diseases Clinic, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), 33100 Udine, Italy
| | - Vittorio Attanasio
- First Division of Infectious Diseases, Cotugno Hospital, Azienda Ospedaliera Dei Colli, 80131 Napoli, Italy
| | - Luca Segreti
- Second Division of Cardiology, Cardiac-Thoracic and Vascular Department, University Hospital of Pisa, 56126 Pisa, Italy
| | - Andrea Ripoli
- Bioengineering Department, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy
| | - Francesco Sbrana
- Lipoapheresis Unit, Reference Center for Diagnosis and Treatment of Inherited Dyslipidemias, Fondazione Toscana "Gabriele Monasterio", Via Moruzzi 1, 56124 Pisa, Italy
| | - Sergio Severino
- UOSD Cardiologia, Cotugno Hospital, Azienda Ospedaliera Dei Colli, 80131 Napoli, Italy
| | - Chiara Sordelli
- UOSD Cardiologia, Cotugno Hospital, Azienda Ospedaliera Dei Colli, 80131 Napoli, Italy
| | - Sara Hana Weisz
- UOSD Cardiologia, Cotugno Hospital, Azienda Ospedaliera Dei Colli, 80131 Napoli, Italy
| | - Agnese Zanus-Fortes
- Infectious Diseases Clinic, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), 33100 Udine, Italy
| | - Gabriele Maria Leanza
- Infectious Diseases Clinic, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), 33100 Udine, Italy
| | - Novella Carannante
- First Division of Infectious Diseases, Cotugno Hospital, Azienda Ospedaliera Dei Colli, 80131 Napoli, Italy
| | - Andrea Di Cori
- Second Division of Cardiology, Cardiac-Thoracic and Vascular Department, University Hospital of Pisa, 56126 Pisa, Italy
| | - Maria Grazia Bongiorni
- Second Division of Cardiology, Cardiac-Thoracic and Vascular Department, University Hospital of Pisa, 56126 Pisa, Italy
| | - Giulio Zucchelli
- Second Division of Cardiology, Cardiac-Thoracic and Vascular Department, University Hospital of Pisa, 56126 Pisa, Italy
| | - Stefano De Vivo
- UOC di Elettrofisiologia, Studio e Terapia delle Aritmie, Monaldi Hospital, 80131 Napoli, Italy
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Cimmino G, Bottino R, Formisano T, Orlandi M, Molinari D, Sperlongano S, Castaldo P, D’Elia S, Carbone A, Palladino A, Forte L, Coppolino F, Torella M, Coppola N. Current Views on Infective Endocarditis: Changing Epidemiology, Improving Diagnostic Tools and Centering the Patient for Up-to-Date Management. Life (Basel) 2023; 13:life13020377. [PMID: 36836734 PMCID: PMC9965398 DOI: 10.3390/life13020377] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/08/2023] [Accepted: 01/23/2023] [Indexed: 01/31/2023] Open
Abstract
Infective endocarditis (IE) is a rare but potentially life-threatening disease, sometimes with longstanding sequels among surviving patients. The population at high risk of IE is represented by patients with underlying structural heart disease and/or intravascular prosthetic material. Taking into account the increasing number of intravascular and intracardiac procedures associated with device implantation, the number of patients at risk is growing too. If bacteremia develops, infected vegetation on the native/prosthetic valve or any intracardiac/intravascular device may occur as the final result of invading microorganisms/host immune system interaction. In the case of IE suspicion, all efforts must be focused on the diagnosis as IE can spread to almost any organ in the body. Unfortunately, the diagnosis of IE might be difficult and require a combination of clinical examination, microbiological assessment and echocardiographic evaluation. There is a need of novel microbiological and imaging techniques, especially in cases of blood culture-negative. In the last few years, the management of IE has changed. A multidisciplinary care team, including experts in infectious diseases, cardiology and cardiac surgery, namely, the Endocarditis Team, is highly recommended by the current guidelines.
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Affiliation(s)
- Giovanni Cimmino
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
- Correspondence: or ; Tel.: +39-0815664141
| | - Roberta Bottino
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, 80138 Napoli, Italy
| | - Tiziana Formisano
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, 80138 Napoli, Italy
| | - Massimiliano Orlandi
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, 80138 Napoli, Italy
| | - Daniele Molinari
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, 80138 Napoli, Italy
| | - Simona Sperlongano
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Pasquale Castaldo
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, 80138 Napoli, Italy
| | - Saverio D’Elia
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, 80138 Napoli, Italy
| | - Andreina Carbone
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, 80138 Napoli, Italy
| | - Alberto Palladino
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, 80138 Napoli, Italy
| | - Lavinia Forte
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, 80138 Napoli, Italy
| | - Francesco Coppolino
- Department of Women, Child and General and Specialized Surgery, Section of Anaesthesiology, University of Campania Luigi Vanvitelli, Piazza Miraglia 2, 80138 Naples, Italy
| | - Michele Torella
- Department of Translational Medical Sciences, Section of Cardiac Surgery and Heart Transplant, University of Campania Luigi Vanvitelli, 81100 Caserta, Italy
| | - Nicola Coppola
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, 81100 Caserta, Italy
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Caldara M, Belgiovine C, Secchi E, Rusconi R. Environmental, Microbiological, and Immunological Features of Bacterial Biofilms Associated with Implanted Medical Devices. Clin Microbiol Rev 2022; 35:e0022120. [PMID: 35044203 PMCID: PMC8768833 DOI: 10.1128/cmr.00221-20] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The spread of biofilms on medical implants represents one of the principal triggers of persistent and chronic infections in clinical settings, and it has been the subject of many studies in the past few years, with most of them focused on prosthetic joint infections. We review here recent works on biofilm formation and microbial colonization on a large variety of indwelling devices, ranging from heart valves and pacemakers to urological and breast implants and from biliary stents and endoscopic tubes to contact lenses and neurosurgical implants. We focus on bacterial abundance and distribution across different devices and body sites and on the role of environmental features, such as the presence of fluid flow and properties of the implant surface, as well as on the interplay between bacterial colonization and the response of the human immune system.
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Affiliation(s)
- Marina Caldara
- Interdepartmental Center on Safety, Technologies, and Agri-food Innovation (SITEIA.PARMA), University of Parma, Parma, Italy
| | - Cristina Belgiovine
- IRCCS Humanitas Research Hospital, Rozzano–Milan, Italy
- Scuola di Specializzazione in Microbiologia e Virologia, Università degli Studi di Pavia, Pavia, Italy
| | - Eleonora Secchi
- Institute of Environmental Engineering, ETH Zürich, Zürich, Switzerland
| | - Roberto Rusconi
- IRCCS Humanitas Research Hospital, Rozzano–Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele–Milan, Italy
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Enterococcus durans Cardiac Implantable Electronic Device Lead Infection and Review of Enterococcus durans Endocarditis Cases. Medicina (B Aires) 2022; 58:medicina58020307. [PMID: 35208630 PMCID: PMC8879582 DOI: 10.3390/medicina58020307] [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: 01/05/2022] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction: Cardiac implantable electronic device (CIED) infections present a growing problem in medicine due to a significant increase in the number of implanted devices and the age of the recipient population. Enterococcus spp. are Gram-positive, facultative anaerobic, lactic acid bacteria; they are relatively common pathogens in humans, but uncommon as the cause of CIED lead infections. Only eight cases of Enterococcus durans endocarditis have been reported in the literature thus far; however, there are no reported cases of Enterococcus durans CIED lead infection. Case presentation: A 58-year-old gentleman with a previously implanted St. Jude Medical single-chamber implantable cardioverter–defibrillator (ICD) due to tachy/brady arrhythmias presented with nonspecific constitutional symptoms (i.e., low-grade fevers, chills, fatigue), and was found to have innumerable bilateral pulmonary nodules via computed tomography angiography of the chest. Many of these pulmonary nodules were cavitated and highly concerning for septic pulmonary emboli and infarcts. Within 24 h from presentation, blood cultures in all four culture bottles grew ampicillin- and vancomycin-susceptible Enterococcus durans. Transthoracic echocardiogram confirmed vegetations on the ICD lead in the right ventricle. The patient underwent laser extraction of the ICD lead with generator removal and recovered completely after a 6-week intravenous antibiotic course. Conclusion: To our knowledge, this is the first report of CIED lead infection caused by Enterococcus durans. In this case, management with antibiotics along with ICD lead extraction led to complete recovery. Clinicians should be aware of this rare but potentially devastating infection in patients with native and artificial valves, but also in those with CIEDs.
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El-Ashry AH, Hussein MSA, Saad K, El Elhoufey A. Clinical utility of sonication for diagnosing infection and colonization of cardiovascular implantable electronic devices. Med Microbiol Immunol 2021; 210:245-250. [PMID: 34254192 DOI: 10.1007/s00430-021-00717-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 07/05/2021] [Indexed: 02/08/2023]
Abstract
Our study aimed to evaluate the sensitivity of the sonication tool for the microbiological diagnosis of cardiovascular implantable electronic device infections (CIEDIs). The extracted cardiac implants of 52 patients were assessed: 19 with CIEDI and 33 with elective generator replacement or revision without clinical infection. Sonication fluid culture of explanted CIEDs yielded higher numbers of microorganisms than pocket tissue or swab cultures. The sensitivity of sonication fluid culture was significantly higher than that of pocket swab and tissue culture for microbiological diagnosis of CIEDI. The microorganisms isolated most frequently via sonication of explanted CIEDs were Gram-positive cocci (70%), of which 50% was coagulase-negative Staphylococcus. Sonication fluid culture detected colonization in 36.4% of the non-infected patients. Sonication fluid culture represents a promising diagnostic strategy with increased sensitivity compared to conventional culture methods for microbiological diagnosis of cardiac devices associated with infection and colonization.
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Affiliation(s)
- Amira H El-Ashry
- Medical Microbiology and Immunology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | - Khaled Saad
- Pediatrics, Faculty of Medicine, Assiut University, Assiut, 71516, Egypt.
| | - Amira El Elhoufey
- Department of Community Health Nursing, Faculty of Nursing, Assiut University, Assiut, Egypt
- Department of Community Health Nursing, Alddrab University College, Jazan University, Jazan, Kingdom of Saudi Arabia
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11
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Lin G, Zou T, Dong M, Liu J, Cui W, Tong J, Shi H, Chen H, Chong J, Lyu Y, Wu S, Wang Z, Jin X, Gao X, Sun L, Qu Y, Yang J. Risk Stratifying and Prognostic Analysis of Subclinical Cardiac Implantable Electronic Devices Infection: Insight From Traditional Bacterial Culture. J Am Heart Assoc 2021; 10:e022260. [PMID: 34729993 PMCID: PMC8751915 DOI: 10.1161/jaha.121.022260] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Subclinical infection of cardiac implantable electronic devices (CIEDs) is a common condition and increases the risk of clinical infection. However, there are limited studies focused on risk stratifying and prognostic analysis of subclinical CIED infection. Methods and Results Data from 418 consecutive patients undergoing CIED replacement or upgrade between January 2011 and December 2019 were used in the analysis. Among the patients included, 50 (12.0%) were detected as positive by bacterial culture of pocket tissues. The most frequently isolated bacteria were coagulase‐negative staphylococci (76.9%). Compared with the noninfection group, more patients in the subclinical infection group were taking immunosuppressive agents, received electrode replacement, or received CIED upgrade and temporary pacing. Patients in the subclinical infection group had a higher PADIT (Prevention of Arrhythmia Device Infection Trial) score. Univariable and multivariable logistic regression analysis found that use of immunosuppressive agents (odds ratio [OR], 6.95 [95% CI, 1.44–33.51]; P=0.02) and electrode replacement or CIED upgrade (OR, 6.73 [95% CI, 2.23–20.38]; P=0.001) were significantly associated with subclinical CIED infection. Meanwhile, compared with the low‐risk group, patients in the intermediate/high‐risk group had a higher risk of subclinical CIED infection (OR, 3.43 [95% CI, 1.58–7.41]; P=0.002). After a median follow‐up time of 36.5 months, the end points between the subclinical infection group and noninfection group were as follows: composite events (58.0% versus 41.8%, P=0.03), rehospitalization (54.0% versus 32.1%, P=0.002), cardiovascular rehospitalization (32.0% versus 13.9%, P=0.001), CIED infection (2.0% versus 0.5%, P=0.32), all‐cause mortality (28.0% versus 21.5%, P=0.30), and cardiovascular mortality (10.0% versus 7.6%, P=0.57). Conclusions Subclinical CIED infection was a common phenomenon. The PADIT score had significant value for stratifying patients at high risk of subclinical CIED infection. Subclinical CIED infection was associated with increased risks of composite events, rehospitalization, and cardiovascular rehospitalization.
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Affiliation(s)
- Gaofeng Lin
- Department of Cardiology Beijing Hospital National Center of Gerontology Institute of Geriatric Medicine Chinese Academy of Medical Sciences Beijing China.,Graduate School of Peking Union Medical College Chinese Academy of Medical Sciences Beijing China
| | - Tong Zou
- Department of Cardiology Beijing Hospital National Center of Gerontology Institute of Geriatric Medicine Chinese Academy of Medical Sciences Beijing China.,Graduate School of Peking Union Medical College Chinese Academy of Medical Sciences Beijing China
| | - Min Dong
- Department of Cardiology Beijing Hospital National Center of Gerontology Institute of Geriatric Medicine Chinese Academy of Medical Sciences Beijing China
| | - Junpeng Liu
- Department of Cardiology Beijing Hospital National Center of Gerontology Institute of Geriatric Medicine Chinese Academy of Medical Sciences Beijing China
| | - Wen Cui
- Department of Cardiology Beijing Hospital National Center of Gerontology Institute of Geriatric Medicine Chinese Academy of Medical Sciences Beijing China
| | - Jiabin Tong
- Department of Cardiology Beijing Hospital National Center of Gerontology Institute of Geriatric Medicine Chinese Academy of Medical Sciences Beijing China
| | - Haifeng Shi
- Department of Cardiology Beijing Hospital National Center of Gerontology Institute of Geriatric Medicine Chinese Academy of Medical Sciences Beijing China
| | - Hao Chen
- Department of Cardiology Beijing Hospital National Center of Gerontology Institute of Geriatric Medicine Chinese Academy of Medical Sciences Beijing China
| | - Jia Chong
- Department of Cardiology Beijing Hospital National Center of Gerontology Institute of Geriatric Medicine Chinese Academy of Medical Sciences Beijing China
| | - You Lyu
- Department of Cardiology Beijing Hospital National Center of Gerontology Institute of Geriatric Medicine Chinese Academy of Medical Sciences Beijing China
| | - Sujuan Wu
- Department of Cardiology Beijing Hospital National Center of Gerontology Institute of Geriatric Medicine Chinese Academy of Medical Sciences Beijing China
| | - Zhilei Wang
- Department of Cardiology Beijing Hospital National Center of Gerontology Institute of Geriatric Medicine Chinese Academy of Medical Sciences Beijing China
| | - Xin Jin
- Department of Cardiology Beijing Hospital National Center of Gerontology Institute of Geriatric Medicine Chinese Academy of Medical Sciences Beijing China
| | - Xu Gao
- Department of Cardiology Beijing Hospital National Center of Gerontology Institute of Geriatric Medicine Chinese Academy of Medical Sciences Beijing China
| | - Lin Sun
- Department of Cardiology Beijing Hospital National Center of Gerontology Institute of Geriatric Medicine Chinese Academy of Medical Sciences Beijing China
| | - Yimei Qu
- Department of Cardiology Beijing Hospital National Center of Gerontology Institute of Geriatric Medicine Chinese Academy of Medical Sciences Beijing China
| | - Jiefu Yang
- Department of Cardiology Beijing Hospital National Center of Gerontology Institute of Geriatric Medicine Chinese Academy of Medical Sciences Beijing China.,Graduate School of Peking Union Medical College Chinese Academy of Medical Sciences Beijing China
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12
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Malagù M, Vitali F, Brieda A, Cimaglia P, De Raffele M, Tazzari E, Musolino C, Balla C, Serenelli M, Cultrera R, Rapezzi C, Bertini M. Antibiotic prophylaxis based on individual infective risk stratification in cardiac implantable electronic device: the PRACTICE study. Europace 2021; 24:413-420. [PMID: 34487163 PMCID: PMC8892070 DOI: 10.1093/europace/euab222] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 08/02/2021] [Indexed: 11/23/2022] Open
Abstract
Aims In patients undergoing cardiac implantable electronic device (CIED) intervention, routine pre-procedure antibiotic prophylaxis is recommended. A more powerful antibiotic protocol has been suggested in patients at high risk of infection. Stratification of individual infective risk could guide the prophylaxis before CIED procedure. Methods and results Patients undergoing CIED surgery were stratified according to the Shariff score in low and high infective risk. Patients in the ‘low-risk’ group were treated with only two antibiotic administrations while patients in the ‘high-risk’ group were treated with a prolonged 9-day protocol, according to renal function and allergies. We followed-up patients for 250 days with clinical outpatient visit and electronic control of the CIED. As primary endpoint, we evaluated CIED-related infections. A total of 937 consecutive patients were enrolled, of whom 735 were stratified in the ‘low-risk’ group and 202 in the ‘high-risk’ group. Despite different risk profiles, CIED-related infection rate at 250 days was similar in the two groups (8/735 in ‘low risk’ vs. 4/202 in ‘high risk’, P = 0.32). At multivariate analysis, active neoplasia, haematoma, and reintervention were independently associated with CIED-related infection (HR 5.54, 10.77, and 12.15, respectively). Conclusion In a large cohort of patients undergoing CIED procedure, an antibiotic prophylaxis based on individual stratification of infective risk resulted in similar rate of infection between groups at high and low risk of CIED-related infection.
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Affiliation(s)
- Michele Malagù
- Cardiological Center, S. Anna University Hospital, Via Aldo Moro 8, 44124 Cona Ferrara, Italy
| | - Francesco Vitali
- Cardiological Center, S. Anna University Hospital, Via Aldo Moro 8, 44124 Cona Ferrara, Italy
| | - Alessandro Brieda
- Cardiological Center, S. Anna University Hospital, Via Aldo Moro 8, 44124 Cona Ferrara, Italy
| | - Paolo Cimaglia
- Cardiological Center, S. Anna University Hospital, Via Aldo Moro 8, 44124 Cona Ferrara, Italy
| | - Martina De Raffele
- Cardiological Center, S. Anna University Hospital, Via Aldo Moro 8, 44124 Cona Ferrara, Italy
| | - Enea Tazzari
- Cardiological Center, S. Anna University Hospital, Via Aldo Moro 8, 44124 Cona Ferrara, Italy
| | - Cristina Musolino
- Cardiological Center, S. Anna University Hospital, Via Aldo Moro 8, 44124 Cona Ferrara, Italy
| | - Cristina Balla
- Cardiological Center, S. Anna University Hospital, Via Aldo Moro 8, 44124 Cona Ferrara, Italy
| | - Matteo Serenelli
- Cardiological Center, S. Anna University Hospital, Via Aldo Moro 8, 44124 Cona Ferrara, Italy
| | - Rosario Cultrera
- Infectious Disease Unit, S. Anna University Hospital, Ferrara, Italy
| | - Claudio Rapezzi
- Cardiological Center, S. Anna University Hospital, Via Aldo Moro 8, 44124 Cona Ferrara, Italy
| | - Matteo Bertini
- Cardiological Center, S. Anna University Hospital, Via Aldo Moro 8, 44124 Cona Ferrara, Italy
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13
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Blomström-Lundqvist C, Traykov V, Erba PA, Burri H, Nielsen JC, Bongiorni MG, Poole J, Boriani G, Costa R, Deharo JC, Epstein LM, Saghy L, Snygg-Martin U, Starck C, Tascini C, Strathmore N. European Heart Rhythm Association (EHRA) international consensus document on how to prevent, diagnose, and treat cardiac implantable electronic device infections-endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), the Latin American Heart Rhythm Society (LAHRS), International Society for Cardiovascular Infectious Diseases (ISCVID) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Europace 2021; 22:515-549. [PMID: 31702000 PMCID: PMC7132545 DOI: 10.1093/europace/euz246] [Citation(s) in RCA: 203] [Impact Index Per Article: 67.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 08/19/2019] [Indexed: 01/28/2023] Open
Abstract
Pacemakers, implantable cardiac defibrillators, and cardiac resynchronization therapy devices are potentially life-saving treatments for a number of cardiac conditions, but are not without risk. Most concerning is the risk of a cardiac implantable electronic device (CIED) infection, which is associated with significant morbidity, increased hospitalizations, reduced survival, and increased healthcare costs. Recommended preventive strategies such as administration of intravenous antibiotics before implantation are well recognized. Uncertainties have remained about the role of various preventive, diagnostic, and treatment measures such as skin antiseptics, pocket antibiotic solutions, anti-bacterial envelopes, prolonged antibiotics post-implantation, and others. Guidance on whether to use novel device alternatives expected to be less prone to infections and novel oral anticoagulants is also limited, as are definitions on minimum quality requirements for centres and operators and volumes. Moreover, an international consensus document on management of CIED infections is lacking. The recognition of these issues, the dissemination of results from important randomized trials focusing on prevention of CIED infections, and observed divergences in managing device-related infections as found in an European Heart Rhythm Association worldwide survey, provided a strong incentive for a 2019 International State-of-the-art Consensus document on risk assessment, prevention, diagnosis, and treatment of CIED infections.
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Affiliation(s)
| | - Vassil Traykov
- Department of Invasive Electrophysiology and Cardiac Pacing, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Paola Anna Erba
- Nuclear Medicine, Department of Translational Research and New Technology in Medicine, University of Pisa, Pisa, Italy, and University of Groningen, University Medical Center Groningen, Medical Imaging Center, Groningen, The Netherlands
| | - Haran Burri
- Department of Cardiology, University Hospital of Geneva, Geneva, Switzerland
| | | | - Maria Grazia Bongiorni
- Division of Cardiology and Arrhythmology, CardioThoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Jeanne Poole
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Giuseppe Boriani
- Division of Cardiology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Roberto Costa
- Department of Cardiovascular Surgery, Heart Institute (InCor) of the University of São Paulo, São Paulo, Brazil
| | - Jean-Claude Deharo
- Department of Cardiology, Aix Marseille Université, CHU la Timone, Marseille, France
| | - Laurence M Epstein
- Electrophysiology, Northwell Health, Hofstra/Northwell School of Medicine, Manhasset, NY, USA
| | - Laszlo Saghy
- Division of Electrophysiology, 2nd Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| | - Ulrika Snygg-Martin
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christoph Starck
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Carlo Tascini
- First Division of Infectious Diseases, Cotugno Hospital, Azienda ospedaliera dei Colli, Naples, Italy
| | - Neil Strathmore
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
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14
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Blomström-Lundqvist C, Traykov V, Erba PA, Burri H, Nielsen JC, Bongiorni MG, Poole J, Boriani G, Costa R, Deharo JC, Epstein LM, Saghy L, Snygg-Martin U, Starck C, Tascini C, Strathmore N. European Heart Rhythm Association (EHRA) international consensus document on how to prevent, diagnose, and treat cardiac implantable electronic device infections-endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), the Latin American Heart Rhythm Society (LAHRS), International Society for Cardiovascular Infectious Diseases (ISCVID) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur J Cardiothorac Surg 2021; 57:e1-e31. [PMID: 31724720 DOI: 10.1093/ejcts/ezz296] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 08/19/2019] [Indexed: 12/26/2022] Open
Abstract
Pacemakers, implantable cardiac defibrillators, and cardiac resynchronization therapy devices are potentially life-saving treatments for a number of cardiac conditions, but are not without risk. Most concerning is the risk of a cardiac implantable electronic device (CIED) infection, which is associated with significant morbidity, increased hospitalizations, reduced survival, and increased healthcare costs. Recommended preventive strategies such as administration of intravenous antibiotics before implantation are well recognized. Uncertainties have remained about the role of various preventive, diagnostic, and treatment measures such as skin antiseptics, pocket antibiotic solutions, anti-bacterial envelopes, prolonged antibiotics post-implantation, and others. Guidance on whether to use novel device alternatives expected to be less prone to infections and novel oral anticoagulants is also limited, as are definitions on minimum quality requirements for centres and operators and volumes. Moreover, an international consensus document on management of CIED infections is lacking. The recognition of these issues, the dissemination of results from important randomized trials focusing on prevention of CIED infections, and observed divergences in managing device-related infections as found in an European Heart Rhythm Association worldwide survey, provided a strong incentive for a 2019 International State-of-the-art Consensus document on risk assessment, prevention, diagnosis, and treatment of CIED infections.
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Affiliation(s)
| | - Vassil Traykov
- Department of Invasive Electrophysiology and Cardiac Pacing, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Paola Anna Erba
- Nuclear Medicine, Department of Translational Research and New Technology in Medicine, University of Pisa, Pisa, Italy, and University of Groningen, University Medical Center Groningen, Medical Imaging Center, Groningen, Netherlands
| | - Haran Burri
- Department of Cardiology, University Hospital of Geneva, Geneva, Switzerland
| | | | - Maria Grazia Bongiorni
- Division of Cardiology and Arrhythmology, CardioThoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Jeanne Poole
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Giuseppe Boriani
- Division of Cardiology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Roberto Costa
- Department of Cardiovascular Surgery, Heart Institute (InCor) of the University of São Paulo, São Paulo, Brazil
| | - Jean-Claude Deharo
- Department of Cardiology, Aix Marseille Université, CHU la Timone, Marseille, France
| | - Laurence M Epstein
- Electrophysiology, Northwell Health, Hofstra/Northwell School of Medicine, Manhasset, NY, USA
| | - Laszlo Saghy
- Division of Electrophysiology, 2nd Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| | - Ulrika Snygg-Martin
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christoph Starck
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Carlo Tascini
- First Division of Infectious Diseases, Cotugno Hospital, Azienda ospedaliera dei Colli, Naples, Italy
| | - Neil Strathmore
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
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15
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Albano M, Greenwood-Quaintance KE, Karau MJ, Mandrekar JN, Patel R. Anti-biofilm activity of antibiotic-loaded Hylomate®. IJC HEART & VASCULATURE 2021; 34:100801. [PMID: 34159252 PMCID: PMC8203729 DOI: 10.1016/j.ijcha.2021.100801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/13/2021] [Accepted: 05/15/2021] [Indexed: 11/30/2022]
Abstract
Introduction Antibiotic envelopes are being developed for cardiac implantable electronic device (CIED) wrapping to reduce the risk of infections. Methods Fifteen CIED infection-associated bacterial isolates of Staphylococcus aureus, Staphylococcus epidermidis and Cutibacterium acnes were used to assess in vitro biofilm formation on Hylomate® compared to titanium, silicone and polyurethane coupons pre-treated with vancomycin (400 µg/ml), bacitracin (1000 U/ml) or a combination of rifampin (80 µg/ml) plus minocycline (50 µg/ml). Scanning electron microscopy (SEM) was performed to visualize bacteria on Hylomate®. Results There was significantly less (p < 0.05) S. aureus and S. epidermidis on Hylomate® pre-treated with vancomycin, bacitracin or rifampin plus minocycline after 24 h of incubation (≤1.00 log10 CFU/cm2) compared with titanium, silicone or polyurethane pre-treated with vancomycin, bacitracin or rifampin plus minocycline. C. acnes biofilms were not detected (≤1.00 log10 CFU/cm2) on pre-treated Hylomate® coupons. Conclusions This study showed that Hylomate® coupons pre-treated with antibiotics reduced staphylococcal and C. acnes biofilm formation in vitro.
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Affiliation(s)
- Mariana Albano
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Kerryl E Greenwood-Quaintance
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Melissa J Karau
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Jayawant N Mandrekar
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States
| | - Robin Patel
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States.,Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, United States
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16
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Blomstrom-Lundqvist C, Ostrowska B. Prevention of cardiac implantable electronic device infections: guidelines and conventional prophylaxis. Europace 2021; 23:euab071. [PMID: 34037227 PMCID: PMC8221047 DOI: 10.1093/europace/euab071] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/09/2021] [Indexed: 01/19/2023] Open
Abstract
Cardiac implantable electronic devices (CIED) are potentially life-saving treatments for several cardiac conditions, but are not without risk. Despite dissemination of recommended strategies for prevention of device infections, such as administration of antibiotics before implantation, infection rates continue to rise resulting in escalating health care costs. New trials conveying important steps for better prevention of device infection and an EHRA consensus paper were recently published. This document will review the role of various preventive measures for CIED infection, emphasizing the importance of adhering to published recommendations. The document aims to provide guidance on how to prevent CIED infections in clinical practice by considering modifiable and non-modifiable risk factors that may be present pre-, peri-, and/or post-procedure.
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Affiliation(s)
| | - Bozena Ostrowska
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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17
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Blomström-Lundqvist C, Traykov V, Erba PA, Burri H, Nielsen JC, Bongiorni MG, Poole J, Boriani G, Costa R, Deharo JC, Epstein LM, Sághy L, Snygg-Martin U, Starck C, Tascini C, Strathmore N. European Heart Rhythm Association (EHRA) international consensus document on how to prevent, diagnose, and treat cardiac implantable electronic device infections-endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), the Latin American Heart Rhythm Society (LAHRS), International Society for Cardiovascular Infectious Diseases (ISCVID), and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2021; 41:2012-2032. [PMID: 32101604 DOI: 10.1093/eurheartj/ehaa010] [Citation(s) in RCA: 107] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/07/2019] [Accepted: 01/10/2020] [Indexed: 01/07/2023] Open
Abstract
Pacemakers, implantable cardiac defibrillators, and cardiac resynchronization therapy devices are potentially lifesaving treatments for a number of cardiac conditions but are not without risk. Most concerning is the risk of a cardiac implantable electronic device (CIED) infection, which is associated with significant morbidity, increased hospitalizations, reduced survival, and increased health care costs. Recommended preventive strategies such as administration of intravenous antibiotics before implantation are well-recognized. Uncertainties have remained about the role of various preventive, diagnostic, and treatment measures such as skin antiseptics, pocket antibiotic solutions, antibacterial envelopes, prolonged antibiotics post-implantation, and others. When compared with previous guidelines or consensus statements, the present consensus document gives guidance on the use of novel device alternatives, novel oral anticoagulants, antibacterial envelopes, prolonged antibiotics post-implantation, as well as definitions on minimum quality requirements for centres and operators and volumes. The recognition that an international consensus document focused on management of CIED infections is lacking, the dissemination of results from new important randomized trials focusing on prevention of CIED infections, and observed divergences in managing device-related infections as found in an European Heart Rhythm Association worldwide survey, provided a strong incentive for a Novel 2019 International State-of-the-art Consensus document on risk assessment, prevention, diagnosis, and treatment of CIED infections.
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Affiliation(s)
| | - Vassil Traykov
- Department of Invasive Electrophysiology and Cardiac Pacing, Acibadem City Clinic Tokuda Hospital, Nikola Vaptsarov blvd 51 B, 1 407 Sofia, Bulgaria
| | - Paola Anna Erba
- Department of Translational Research and New Technology in Medicine, University of Pisa-AOUP, Lungarno Antonio Pacinotti, 43, 56126 Pisa PI, Italy.,Department of Nuclear Medicine & Molecular Imaging University Medical Center Groningen, University of Groningen, 9712 CP Groningen, Netherlands
| | - Haran Burri
- Department of Cardiology, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200 Aarhus, Denmark
| | - Maria Grazia Bongiorni
- CardioThoracic and Vascular Department, University Hospital of Pisa, Via Paradisa 2, 56125 Pisa PI, Italy
| | - Jeanne Poole
- Department of Cardiology, University of Washington, Roosevelt Way NE, Seattle, WA 98115, USA
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Largo del Pozzo, 71, 41125 Modena, Italy
| | - Roberto Costa
- Department of Cardiovascular Surgery, Heart Institute (InCor) of the University of São Paulo, Butanta, São Paulo - State of São Paulo, Brazil
| | - Jean-Claude Deharo
- Department of Cardiology, Aix Marseille Université, CHU la Timone, 278 Rue Saint-Pierre, 13005 Marseille, France
| | - Laurence M Epstein
- Electrophysiology, Northwell Health, Hofstra/Northwell School of Medicine, 300 Community Drive, Manhasset, NY 11030, USA
| | - László Sághy
- Electrophysiology Division, 2nd Department of Medicine and Cardiology Centre, University of Szeged, Aradi vértanúk tere 1, 6720 Szeged, Hungary
| | - Ulrika Snygg-Martin
- Department of Infectious Diseases, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Christoph Starck
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Pl. 1, 13353 Berlin, Germany
| | - Carlo Tascini
- First Division of Infectious Diseases, Cotugno Hospital, Azienda ospedaliera dei Colli, Via Gaetano Quagliariello, 54, 80131 Napoli NA, Italy
| | - Neil Strathmore
- Department of Cardiology, Royal Melbourne Hospital, 300 Grattan St, Parkville VIC 3050, Melbourne, Australia
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18
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Vasilev S. Strategies for Prevention of Surgical Site Infection in Patients With CIED Implantation: A Literature Review. Cureus 2021; 13:e13021. [PMID: 33542887 PMCID: PMC7849920 DOI: 10.7759/cureus.13021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
In the last several years a stable increase in cardiovascular implantable electronic device (CIED) implantation has been seen, mainly because of the expanded indications for their usage. An important complication of CIED implantation is possible postprocedural infection (pocket or systemic), which is connected with high morbidity and mortality rates and carries a significant financial cost to the health systems. Although this complication is not that frequent (ranging from 1% to over 5% in different studies), it is associated with a significant burden to patients, clinicians, and the healthcare system and because of that attention should be placed on the prevention of the infection. In this article, we collected and summarized the information and data available, directly related to the problem of prevention of CIED infection. The results of different studies and guidelines, regarding prevention with antibiotics, antiseptics, and the usage of antibacterial envelopes are analyzed. Perspective is put on the new technology of using antibacterial envelopes for prevention of infections. The aim of this paper is to review the various infection prevention techniques and to highlight the most beneficial ones according to guidelines and worldwide studies.
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19
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Han Q, Lau JW, Do TC, Zhang Z, Xing B. Near-Infrared Light Brightens Bacterial Disinfection: Recent Progress and Perspectives. ACS APPLIED BIO MATERIALS 2020; 4:3937-3961. [DOI: 10.1021/acsabm.0c01341] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Qinyu Han
- Division of Chemistry and Biological Chemistry, School of Physical & Mathematical Sciences, Nanyang Technological University, Singapore 637371, Singapore
| | - Jun Wei Lau
- Division of Chemistry and Biological Chemistry, School of Physical & Mathematical Sciences, Nanyang Technological University, Singapore 637371, Singapore
| | - Thang Cong Do
- Division of Chemistry and Biological Chemistry, School of Physical & Mathematical Sciences, Nanyang Technological University, Singapore 637371, Singapore
| | - Zhijun Zhang
- Department of Chemistry, Zhejiang Sci-Tech University, Hangzhou 310018, China
| | - Bengang Xing
- Division of Chemistry and Biological Chemistry, School of Physical & Mathematical Sciences, Nanyang Technological University, Singapore 637371, Singapore
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore 637549, Singapore
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20
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Talha KM, DeSimone DC, Sohail MR, Baddour LM. Pathogen influence on epidemiology, diagnostic evaluation and management of infective endocarditis. Heart 2020; 106:1878-1882. [PMID: 32847941 DOI: 10.1136/heartjnl-2020-317034] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/18/2020] [Accepted: 07/22/2020] [Indexed: 12/23/2022] Open
Abstract
Infective endocarditis (IE) is uncommon and has, in the past, been most often caused by viridans group streptococci (VGS). Due to the indolent nature of these organisms, the phrase 'subacute bacterial endocarditis', so-called 'SBE', was routinely used as it characterised the clinical course of most patients that extended for weeks to months. However, in more recent years, there has been a significant shift in the microbiology of IE with the emergence of staphylococci as the most frequent pathogens, and for IE due to Staphylococcus aureus, the clinical course is acute and can be associated with sepsis. Moreover, increases in IE due to enterococci have occurred and have been characterised by treatment-related complications and worse outcomes. These changes in pathogen distribution have been attributed to a diversification in the target population at risk of IE. While prosthetic valve endocarditis and history of IE remain at highest risk of IE, the rise in prevalence of injection drug use, intracardiac device implantations and other healthcare exposures have heavily contributed to the existing pool of at-risk patients. This review focuses on common IE pathogens and their impact on the clinical profile of IE.
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Affiliation(s)
- Khawaja M Talha
- Division of Infectious Diseases, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - Daniel C DeSimone
- Division of Infectious Diseases, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.,Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.,Department of Cardiovascular Diseases, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - M Rizwan Sohail
- Division of Infectious Diseases, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.,Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.,Department of Cardiovascular Diseases, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - Larry M Baddour
- Division of Infectious Diseases, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.,Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.,Department of Cardiovascular Diseases, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
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21
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Garweg C, Vandenberk B, Jentjens S, Foulon S, Hermans P, Poels P, Haemers P, Ector J, Willems R. Bacteraemia after leadless pacemaker implantation. J Cardiovasc Electrophysiol 2020; 31:2440-2447. [DOI: 10.1111/jce.14671] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/06/2020] [Accepted: 07/10/2020] [Indexed: 01/01/2023]
Affiliation(s)
- Christophe Garweg
- Department of Cardiology University Hospitals Leuven Leuven Belgium
- Department of Cardiovascular Sciences University of Leuven Leuven Belgium
| | - Bert Vandenberk
- Department of Cardiology University Hospitals Leuven Leuven Belgium
| | - Sander Jentjens
- Department of Nuclear Medicine University Hospitals Leuven Leuven Belgium
| | - Stefaan Foulon
- Department of Cardiology University Hospitals Leuven Leuven Belgium
| | - Patrick Hermans
- Department of Cardiology University Hospitals Leuven Leuven Belgium
| | - Patricia Poels
- Department of Cardiology University Hospitals Leuven Leuven Belgium
| | - Peter Haemers
- Department of Cardiology University Hospitals Leuven Leuven Belgium
- Department of Cardiovascular Sciences University of Leuven Leuven Belgium
| | - Joris Ector
- Department of Cardiology University Hospitals Leuven Leuven Belgium
- Department of Cardiovascular Sciences University of Leuven Leuven Belgium
| | - Rik Willems
- Department of Cardiology University Hospitals Leuven Leuven Belgium
- Department of Cardiovascular Sciences University of Leuven Leuven Belgium
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22
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Barbar T, Patel R, Thomas G, Cheung JW. Strategies to Prevent Cardiac Implantable Electronic Device Infection. J Innov Card Rhythm Manag 2020; 11:3949-3956. [PMID: 32368364 PMCID: PMC7192142 DOI: 10.19102/icrm.2020.110102] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 10/16/2019] [Indexed: 12/15/2022] Open
Abstract
The association between the risk of mortality and cardiovascular implantable electronic device (CIED) infections has been well-established in the literature. As CIED implantations have increased in frequency in the past few decades, the incidence of CIED-related infections has also risen. Given the morbidity, mortality, and health-care costs associated with CIED infections, the prevention of device-related infection is a critical goal. Risk factors for developing CIED infections can be categorized as patient-, procedure-, or device-related. Numerous studies have highlighted different strategies for preventing CIED-related infections, which include patient optimization, device selection, and periprocedural preparation and treatment. Nonetheless, as the comorbidity burden of patients undergoing CIED implantation continues to increase, significant challenges in the successful elimination of CIED-related infections remain. This review provides a comprehensive overview of available evidence-based approaches and strategies to reduce the risk of CIED infections.
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Affiliation(s)
- Tarek Barbar
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Rohan Patel
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - George Thomas
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Jim W Cheung
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
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23
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Ajam M, Shokr M, Ajam F, Lieberman R. Rare case of implantable cardioverter defibrillator infection caused by Stenotrophomonas maltophilia and Pantoea calida. BMJ Case Rep 2019; 12:12/8/e230506. [PMID: 31471361 DOI: 10.1136/bcr-2019-230506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Despite the numerous advancements in cardiac implantable electronic defibrillator (CIED) designs and implantation techniques, device-related infections continue to represent significant morbidity and mortality. Although Gram-positive bacteria remain the most commonly reported organisms, various other bacterial families have been reported. We describe a 61-year-old patient with a history of non-ischaemic cardiomyopathy who presented with implantable cardioverter defibrillator pocket infection due to Stenotrophomonas maltophilia and Pantoea calida that developed a few days following the device generator replacement. Early device explantation, tissue sampling and initiation of sensitivity-directed antibiotics are necessary steps for early diagnosis and management of such CIED-related infections. S. maltophilia and P. calida should be added to the expanding list of the causative organisms behind CIED-related infections. Our case and available literature demonstrated excellent sensitivity of these two organisms to sulfamethoxazole-trimethoprim treatment.
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Affiliation(s)
- Mustafa Ajam
- Internal Medicine, Detroit Medical Center, Detroit, Michigan, USA
| | - Mohamed Shokr
- Cardiology, DMC/Wayne State University, Detroit, Michigan, USA
| | - Firas Ajam
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, New Jersey, USA
| | - Randy Lieberman
- Cardiology, DMC/Wayne State University, Detroit, Michigan, USA
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24
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El‐Chami MF, Soejima K, Piccini JP, Reynolds D, Ritter P, Okabe T, Friedman PA, Cha Y, Stromberg K, Holbrook R, Fagan DH, Roberts PR. Incidence and outcomes of systemic infections in patients with leadless pacemakers: Data from the Micra IDE study. Pacing Clin Electrophysiol 2019; 42:1105-1110. [DOI: 10.1111/pace.13752] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/04/2019] [Accepted: 06/19/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Mikhael F. El‐Chami
- Division of Cardiology, Section of ElectrophysiologyEmory University Atlanta Georgia
| | | | - Jonathan P. Piccini
- Duke University Medical Center and Duke Clinical Research Institute Durham North Carolina
| | - Dwight Reynolds
- Cardiovascular Section, University of Oklahoma Health Sciences CenterOU Medical Center Oklahoma City Oklahoma
| | - Philippe Ritter
- Department of Cardiac Pacing and ElectrophysiologyCHU/Université de Bordeaux Pessac France
| | - Toshimasa Okabe
- The Ohio State University Wexner Medical Center Columbus Ohio
| | - Paul A. Friedman
- Department of Cardiovascular MedicineMayo Clinic Rochester Minnesota
| | - Yong‐Mei Cha
- Department of Cardiovascular MedicineMayo Clinic Rochester Minnesota
| | | | | | | | - Paul R. Roberts
- University Hospital SouthamptonNHS Foundation Trust Southampton UK
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25
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Golzio PG, Magnano S Lio M, Bongiorni MG. Occult bacteraemia in cardiac implantable electronic device patients: a review of diagnostic workflow and mandatory therapy. J Cardiovasc Med (Hagerstown) 2019; 20:271-277. [PMID: 30624298 DOI: 10.2459/jcm.0000000000000754] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
: Cardiac implantable electronic device (CIED) implantation has greatly increased, with an associated exponential increase in CIED infections (CDIs). Cardiac device related infective endocarditis (CDRIE) has high morbidity and mortality: approximately 10-21%. Therefore, a prompt diagnosis and radical treatment of CDRIE are needed; transvenous lead extraction (TLE) is the mainstay for the complete healing, even if associated with wide logistic problems, high therapeutic costs and high mortality risk for patients. Some criticisms about the value of Duke criteria and their limitations for the diagnosis of CDRIE are known. The significance of classic laboratory data, transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE), considered in the Duke score, are reviewed and critically discussed in this article, with regard to the specific field of the diagnosis of CDI. The need for new techniques for achieving the diagnostic reliability has been well perceived by physicians, and additional techniques have been introduced in the new European Society of Cardiology (ESC) and British Heart Rhythm Society (BHRS) guidelines on infective endocarditis. These suggested techniques, such as 18-Fluorodeoxyglucose PET/computed tomography (FDG-PET/CT), white blood cell PET (WBC PET) and lung multislice CT (MSCT), are also discussed in the study. This short review is intended as an extensive summary of the diagnostic workflow in cases of CDI and will be useful for readers who want to know more about this issue.
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Affiliation(s)
- Pier Giorgio Golzio
- Division of Cardiology, Department of Internal Medicine, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino and University of Turin, Turin
| | - Massimo Magnano S Lio
- Division of Cardiology, Department of Internal Medicine, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino and University of Turin, Turin
| | - Maria Grazia Bongiorni
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
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26
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Refaat M, Zakka P, Khoury M, Chami H, Mansour S, Harbieh B, Abi-Saleh B, Bizri AR. Cardiac implantable electronic device infections: Observational data from a tertiary care center in Lebanon. Medicine (Baltimore) 2019; 98:e14906. [PMID: 31008922 PMCID: PMC6494368 DOI: 10.1097/md.0000000000014906] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
With increasing rates of device implantation, there is an increased recognition of device infection. We conducted a retrospective observational study in a tertiary care center in Lebanon, with data collected from medical records of patients presenting with cardiac implantable electronic device (CIED) infection from 2000 to 2017 with the purpose of identifying etiologies, risk factors and other parameters, and comparing them to available data from the rest of the world. We identified a total of 22 CIED infections. The most common microbial etiologies, including involvement in polymicrobial infection, were coagulase-negative staphylococci (45.5%) and Staphylococcus aureus (22.7%). Rare cases of Brucella melitensis, Sphingomonas paucimobilis, and Kytococcus schroeteri device infection were seen. Heart failure was seen in 77.3% of patients, hypertension in 68.2%, and chronic kidney disease in 50%. Skin changes were the most common presenting symptoms (86.4%). Antibiotics were given to all patients and all had their devices removed, with 36.4% undergoing new device implantation. This is the first study of CIED infections in Lebanon and the Middle East. Local epidemiology and occupational exposure must be considered while contemplating the microbial etiology of infection. Close monitoring after device implantation is important in preventing device infection that carries high risk of morbidity and mortality.
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Affiliation(s)
- Marwan Refaat
- Department of Internal Medicine, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Patrick Zakka
- Department of Internal Medicine, Emory University Hospital, Atlanta, GA, USA
| | - Maurice Khoury
- Department of Internal Medicine, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hassan Chami
- Department of Internal Medicine, Emory University Hospital, Atlanta, GA, USA
| | - Shareef Mansour
- Department of Internal Medicine, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Bernard Harbieh
- Department of Internal Medicine, Division of Cardiology, Keserwan Medical Center
| | - Bernard Abi-Saleh
- Department of Internal Medicine, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Abdul Rahman Bizri
- Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Lebanon
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27
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Busscher HJ, Alt V, van der Mei HC, Fagette PH, Zimmerli W, Moriarty TF, Parvizi J, Schmidmaier G, Raschke MJ, Gehrke T, Bayston R, Baddour LM, Winterton LC, Darouiche RO, Grainger DW. A Trans-Atlantic Perspective on Stagnation in Clinical Translation of Antimicrobial Strategies for the Control of Biomaterial-Implant-Associated Infection. ACS Biomater Sci Eng 2018; 5:402-406. [PMID: 30775431 PMCID: PMC6373985 DOI: 10.1021/acsbiomaterials.8b01071] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 12/01/2018] [Indexed: 12/31/2022]
Abstract
![]()
Current regulatory
requirements impede clinical translation and
market introduction of many new antimicrobial combination implants
and devices, causing unnecessary patient suffering, doctor frustration,
and costs to healthcare payers. Regulatory requirements of antimicrobial
combination implants and devices should be thoroughly revisited and
their approval allowed based on enrichment of benefit demonstrations
from high-risk patient groups and populations or device components
to facilitate their clinical translation. Biomaterial implant and
devices equipped with antimicrobial strategies and approved based
on enrichment claims should be mandatorily enrolled in global registry
studies supervised by regulatory agencies for a minimum five-year
period or until statistically validated evidence for noninferiority
or superiority of claims is demonstrated. With these recommendations,
this trans-Atlantic consortium of academicians and clinicians takes
its responsibility to actively seek to relieve the factors that stagnate
downward clinical translation and availability of antimicrobial combination
implants and devices. Improved dialogue between the various key players
involved in the current translational blockade, which include patients,
academicians and doctors, policymakers, regulatory agencies, manufacturers,
and healthcare payers, is urgently needed.
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Affiliation(s)
- Henk J Busscher
- University of Groningen and University Medical Center Groningen, Department of Biomedical Engineering, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - Volker Alt
- Department of Trauma Surgery, University Hospital Giessen-Marburg, Rudolf-Buchheim strasse 7, 35392 Giessen, Germany
| | - Henny C van der Mei
- University of Groningen and University Medical Center Groningen, Department of Biomedical Engineering, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - Paul H Fagette
- University of Groningen and University Medical Center Groningen, Department of Biomedical Engineering, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - Werner Zimmerli
- Basel University Medical Clinic, Kantonsspital Baselland, Rheinstrasse 26, CH-4410 Liestal, Switzerland
| | - T Fintan Moriarty
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos Platz, Switzerland
| | - Javad Parvizi
- Department of Orthopedic Surgery, Rothman Institute at Jefferson, Thomas Jefferson University, Center City Philadelphia, 925 Chestnut Street, Fifth Floor, Philadelphia, Pennsylvania 19107, United States
| | - Gerhard Schmidmaier
- Department of Orthopedic and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - Michael J Raschke
- Department of Trauma, Hand, and Reconstructive Surgery, University of Muenster, Albert-Schweizer-Campus, D-48149 Muenster, Germany
| | - Thorsten Gehrke
- Department of Orthopedic Joint Surgery and Endoprosthetics, HELIOS ENDO-Clinic, Holstenstrasse 2, 22767 Hamburg, Germany
| | - Roger Bayston
- School of Medicine, Queens Medical Center, University of Nottingham, Nottingham NG7 2UH, U.K
| | - Larry M Baddour
- Divisions of Infectious Diseases and Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, United States
| | - Lynn C Winterton
- Better Vision Group, LLC, 808 Sandy Trail, Keller, Texas 76248, United States
| | - Rabih O Darouiche
- Departments of Medicine, Surgery and PM&R, Baylor College of Medicine 1333 Moursund Avenue, Houston, Texas 77030, United States
| | - David W Grainger
- Departments of Bioengineering, Pharmaceutics, and Pharmaceutical Chemistry, University of Utah, 30 South 2000 East, Salt Lake City, Utah 84112-5820, United States
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28
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Approach to Diagnosis of Cardiovascular Implantable-Electronic-Device Infection. J Clin Microbiol 2018; 56:JCM.01683-17. [PMID: 29695526 DOI: 10.1128/jcm.01683-17] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Device infection remains a significant challenge as clinical indications for cardiovascular implantable electronic device (CIED) therapy continue to expand beyond the prevention and treatment of cardiac arrhythmias. Patients receiving CIED therapy are now older and have significant comorbidities, placing them at higher risk of complications, including infection. CIED infection warrants complete device removal, as retention is associated with an unacceptably high risk of relapse and increased mortality. However, accurate diagnosis of CIED infections remains a significant challenge that is based on a combination of findings on physical examination, microbiological and laboratory testing, and advanced imaging, such as transesophageal echocardiography or positron emission tomography. Isolating a causative pathogen and performing susceptibility testing are crucial for appropriate choice, route, and duration of antimicrobial therapy. In this review, we present an evidence-based approach to diagnosis of CIED infection.
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29
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A Case of Pacemaker Endocarditis Caused by Aerococcus urinae. Case Rep Infect Dis 2018; 2018:9128560. [PMID: 29692938 PMCID: PMC5859873 DOI: 10.1155/2018/9128560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 02/07/2018] [Indexed: 11/17/2022] Open
Abstract
Background Aerococcus urinae has lately been acknowledged as a cause of infective endocarditis (IE) especially in older males with underlying urinary tract disorders. In this population, cardiac implanted electronical devices (CIED) are not uncommon, but despite the capacity of A. urinae to form biofilm in vitro, no cases of aerococcal CIED infections have been reported to date. Case Presentation An 84-year-old male with pacemaker was admitted with dysuria one month after a transurethral procedure for urinary bladder cancer. A. urinae was isolated from urine and blood. Transesophageal echocardiography (TEE) was without signs of vegetation on valves or pacing cables. The patient was treated with a twelve-day course of β-lactam antibiotics. Forty days after the initial admission, the patient was readmitted due to malaise, general pain of the joints, chills, and renewed blood cultures grew A. urinae. TEE demonstrated a 10 × 5 mm vegetation on either the tricuspid valve or one of the pacing cables. The pacemaker system was completely removed and demonstrated macroscopic signs of infection. A temporary system was implanted, and after 14 days of penicillin G treatment, a new system permanent system was implanted. Total treatment time was 40 days. Recovery was uneventful. Conclusion This report demonstrates that A. urinae can cause CIED infection. In patients with A. urinae bacteremia and a CIED, this risk must be considered, especially if bacteremia reoccurs.
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30
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Cunha BA, Jimada I. Recurrent FUO due to intermittent Enterobacter cloacaebacteremias from an infected pacemaker lead diagnosed by gallium scan. Infect Dis (Lond) 2018; 50:62-66. [DOI: 10.1080/23744235.2017.1355106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Burke A. Cunha
- Infectious Disease Division, Winthrop-University Hospital, Mineola, NY, USA
- School of Medicine, State University of New York, Stony Brook, NY, USA
| | - Ismail Jimada
- Infectious Disease Division, Winthrop-University Hospital, Mineola, NY, USA
- School of Medicine, State University of New York, Stony Brook, NY, USA
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31
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Boyle TA, Uslan DZ, Prutkin JM, Greenspon AJ, Baddour LM, Danik SB, Tolosana JM, Le K, Miro JM, Peacock JE, Sohail MR, Vikram HR, Carrillo RG. Impact of Abandoned Leads on Cardiovascular Implantable Electronic Device Infections: A Propensity Matched Analysis of MEDIC (Multicenter Electrophysiologic Device Infection Cohort). JACC Clin Electrophysiol 2017; 4:201-208. [PMID: 29749938 DOI: 10.1016/j.jacep.2017.09.178] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 09/14/2017] [Accepted: 09/21/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study sought to evaluate the impact of abandoned cardiovascular implantable electronic device (CIED) leads on the presentation and management of device-related infections. BACKGROUND Device infection is a serious consequence of CIEDs and necessitates removal of all hardware for attempted cure. The merits of extracting or retaining presumed sterile but nonfunctioning leads is a subject of ongoing debate. METHODS The MEDIC (Multicenter Electrophysiologic Device Infection Cohort) prospectively enrolled patients with CIED infections at 10 institutions in the United States and abroad between January 1, 2009, and December 31, 2012. Within a propensity-matched cohort, relevant clinical information was compared between patients who had 1 or more abandoned leads at the time of infection and those who had none. RESULTS Matching produced a cohort of 264 patients, including 176 with no abandoned leads and 88 with abandoned leads. The groups were balanced with respect to Charlson comorbidity index, oldest lead age, device type, sex, and race. At the time of admission, those with abandoned leads were less likely to demonstrate systemic signs of infection, including leukocytosis (p = 0.023) and positive blood cultures (p = 0.005). Conversely, patients with abandoned leads were more likely to demonstrate local signs of infections, including skin erosion (p = 0.031) and positive pocket cultures (p = 0.015). In addition, patients with abandoned leads were more likely to require laser extraction (p = 0.010). CONCLUSIONS The results of a large prospective registry of CIED infections demonstrated that patients with abandoned leads may present with different signs, symptoms, and microbiological findings and require laser extraction more than those without abandoned leads.
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Affiliation(s)
- Thomas A Boyle
- Department of Surgery, Division of Cardiothoracic Surgery, University of Miami, Miami, Florida.
| | - Daniel Z Uslan
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Jordan M Prutkin
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington
| | - Arnold J Greenspon
- Department of Medicine, Division of Cardiology, Cardiac Electrophysiology Laboratory, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Larry M Baddour
- Department of Medicine, Divisions of Infectious Diseases and Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Stephan B Danik
- Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jose M Tolosana
- Cardiology and Infectious Disease Services, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Katherine Le
- Department of Medicine, Divisions of Infectious Diseases and Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Jose M Miro
- Cardiology and Infectious Disease Services, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - James E Peacock
- Department of Medicine, Section of Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Muhammad R Sohail
- Department of Medicine, Divisions of Infectious Diseases and Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota
| | | | - Roger G Carrillo
- Department of Surgery, Division of Cardiothoracic Surgery, University of Miami, Miami, Florida.
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32
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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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33
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Maskarinec SA, Thaden JT, Cyr DD, Ruffin F, Souli M, Fowler VG. The Risk of Cardiac Device-Related Infection in Bacteremic Patients Is Species Specific: Results of a 12-Year Prospective Cohort. Open Forum Infect Dis 2017; 4:ofx132. [PMID: 28852678 PMCID: PMC5570037 DOI: 10.1093/ofid/ofx132] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 06/20/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The species-specific risk of cardiac device-related infection (CDRI) among bacteremic patients is incompletely understood. METHODS We conducted a prospective cohort study of hospitalized patients from October 2002 to December 2014 with a cardiac device (CD) and either Staphylococcus aureus bacteremia (SAB) or Gram-negative bacteremia (GNB). Cardiac devices were defined as either prosthetic heart valves (PHVs), including valvular support rings, permanent pacemakers (PPMs)/automatic implantable cardioverter defibrillators (AICDs), or left ventricular assist devices (LVADs). RESULTS During the study period, a total of 284 patients with ≥1 CD developed either SAB (n = 152 patients) or GNB (n = 132 patients). Among the 284 patients, 150 (52.8%) had PPMs/AICDs, 72 (25.4%) had PHVs, 4 (1.4%) had LVADs, and 58 (20.4%) had >1 device present. Overall, 54.6% of patients with SAB and 16.7% of patients with GNB met criteria for definite CDRI (P < .0001). Multivariable logistic regression analysis revealed that 3 bacterial species were associated with an increased risk for CDRI: Staphylococcus aureus (odds ratio [OR] = 5.57; 95% confidence interval [CI], 2.16-14.36), Pseudomonas aeruginosa (OR = 50.28; 95% CI, 4.16-606.93), and Serratia marcescens (OR = 7.75; 95% CI, 1.48-40.48). CONCLUSIONS Risk of CDRI among patients with bacteremia varies by species. Cardiac device-related infection risk is highest in patients with bacteremia due to S aureus, P aeruginosa, or S marcescens. By contrast, it is lower in patients with bacteremia due to other species of Gram-negative bacilli. Patients with a CD who develop bacteremia due to either P aeruginosa or S marcescens should be considered for diagnostic imaging to evaluate for the presence of CDRI.
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Affiliation(s)
| | - Joshua T Thaden
- Duke University, Division of Infectious Diseases, Durham, North Carolina
| | - Derek D Cyr
- Duke Clinical Research Institute, Durham, North Carolina
| | - Felicia Ruffin
- Duke University, Division of Infectious Diseases, Durham, North Carolina
| | - Maria Souli
- Duke University, Division of Infectious Diseases, Durham, North Carolina.,National and Kapodistrian University of Athens, School of Medicine, Greece
| | - Vance G Fowler
- Duke University, Division of Infectious Diseases, Durham, North Carolina.,Duke Clinical Research Institute, Durham, North Carolina
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Wang R, Li X, Wang Q, Zhang Y, Wang H. Microbiological Characteristics and Clinical Features of Cardiac Implantable Electronic Device Infections at a Tertiary Hospital in China. Front Microbiol 2017; 8:360. [PMID: 28321212 PMCID: PMC5337500 DOI: 10.3389/fmicb.2017.00360] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 02/21/2017] [Indexed: 11/13/2022] Open
Abstract
The incidence of cardiac implantable electronic device (CIED) infections is rapidly increasing worldwide. However, the microbiological characteristics and clinical features of symptomatic CIED infections are not well described. The present study included patients with CIED infections in China, and their pocket tissues were collected for clinical microbiological determination. A total of 219 patients with CIED infections were investigated; of these patients, 145 (66.2%) were positive for CIED infection in pocket tissue cultures and 24 (11.0%) were positive in both blood and pocket tissue cultures. Patients with recurrent infections and patients with systemic infections tended to have higher rates of positive cultures from pocket tissue. In addition, patients with lung diseases were more likely to have early CIED infections than late CIED infections, while patients with liver diseases were more susceptible to systemic infections than local infections. Staphylococcus species were the most common cause of CIED infections; coagulase-negative staphylococci was the predominant type (accounting for 45.2% in all cases and 68.3% in culture-positive cases). None of the Staphylococcus isolates were resistant to gentamicin, linezolid or vancomycin. Gram-negative bacilli accounted for 9.1% of all cases and 13.8% of culture-positive cases. Significant differences in the distribution of different pathogens were identified between primary infections and recurrent infections, between local infections and systemic infections, and between early infections and late infections. Our data describe the microbiological characteristics and clinical features of CIED infections, and provide evidence for advisory guidelines on the management of CIED infections in China.
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Affiliation(s)
- Ruobing Wang
- Department of Clinical Laboratory, Peking University People's Hospital Beijing, China
| | - Xuebin Li
- Department of Cardiology, Peking University People's Hospital Beijing, China
| | - Qi Wang
- Department of Clinical Laboratory, Peking University People's Hospital Beijing, China
| | - Yawei Zhang
- Department of Clinical Laboratory, Peking University People's Hospital Beijing, China
| | - Hui Wang
- Department of Clinical Laboratory, Peking University People's Hospital Beijing, China
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Rosso F, Perafán-Bautista PE, Carrillo-Gómez DC, Ramos-Amézquita MH, Cedano-Rincón J. Infección relacionada con los dispositivos cardiovasculares. REVISTA COLOMBIANA DE CARDIOLOGÍA 2016. [DOI: 10.1016/j.rccar.2016.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Kypta A, Blessberger H, Kammler J, Lambert T, Lichtenauer M, Brandstaetter W, Gabriel M, Steinwender C. Leadless Cardiac Pacemaker Implantation After Lead Extraction in Patients With Severe Device Infection. J Cardiovasc Electrophysiol 2016; 27:1067-71. [PMID: 27296508 DOI: 10.1111/jce.13030] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 06/04/2016] [Accepted: 06/07/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Conventional pacemaker therapy is limited by short- and long-term complications, most notably device infection. Transcatheter pacing systems (TPS) may be beneficial in this kind of patients as they eliminate the need for a device pocket and leads and thus may reduce the risk of re-infection. METHODS We assessed a novel procedure in 6 patients with severe device infection who were pacemaker dependent. After lead extraction a single chamber TPS was implanted into the right ventricle. RESULTS Of the 6 patients who underwent lead extraction due to severe device infection at our institution, 3 were diagnosed with a pocket infection only, whereas the other 3 showed symptoms of both pocket and lead infection. Successful lead extraction and TPS implantation was accomplished in all patients. Four patients were bridged with a temporary pacemaker between 2 hours and 2 days after lead extraction, whereas 2 patients had the TPS implanted during the same procedure just before traditional pacemaker system removal. All patients stayed free of infection during the follow-up period of 12 weeks. An additional positron emission tomography scan was performed in each patient and indicated no signs of an infection around the TPS. CONCLUSION Transcather pacemaker implantation was safe and feasible in 6 patients and did not result in re-infection even if implanted before removal of the infected pacemaker system within the same procedure. Therefore, implantation of a TPS may be an option for patients with severe device infection, especially in those with blocked venous access or who are pacemaker dependent.
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Affiliation(s)
- Alexander Kypta
- Department of Cardiology, Kepler University Hospital Linz, Medical Faculty of the Johannes Kepler University Linz, Linz, Austria.
| | - Hermann Blessberger
- Department of Cardiology, Kepler University Hospital Linz, Medical Faculty of the Johannes Kepler University Linz, Linz, Austria
| | - Juergen Kammler
- Department of Cardiology, Kepler University Hospital Linz, Medical Faculty of the Johannes Kepler University Linz, Linz, Austria
| | - Thomas Lambert
- Department of Cardiology, Kepler University Hospital Linz, Medical Faculty of the Johannes Kepler University Linz, Linz, Austria
| | - Michael Lichtenauer
- Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Walter Brandstaetter
- Institute of Nuclear Medicine and Endocrinology, Kepler University Hospital Linz, Medical Faculty of the Johannes Kepler University Linz, Linz, Austria
| | - Michael Gabriel
- Institute of Nuclear Medicine and Endocrinology, Kepler University Hospital Linz, Medical Faculty of the Johannes Kepler University Linz, Linz, Austria
| | - Clemens Steinwender
- Department of Cardiology, Kepler University Hospital Linz, Medical Faculty of the Johannes Kepler University Linz, Linz, Austria
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Zheng Q, Zhang H, Shi B, Xue X, Liu Z, Jin Y, Ma Y, Zou Y, Wang X, An Z, Tang W, Zhang W, Yang F, Liu Y, Lang X, Xu Z, Li Z, Wang ZL. In Vivo Self-Powered Wireless Cardiac Monitoring via Implantable Triboelectric Nanogenerator. ACS NANO 2016; 10:6510-8. [PMID: 27253430 DOI: 10.1021/acsnano.6b02693] [Citation(s) in RCA: 147] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Harvesting biomechanical energy in vivo is an important route in obtaining sustainable electric energy for powering implantable medical devices. Here, we demonstrate an innovative implantable triboelectric nanogenerator (iTENG) for in vivo biomechanical energy harvesting. Driven by the heartbeat of adult swine, the output voltage and the corresponding current were improved by factors of 3.5 and 25, respectively, compared with the reported in vivo output performance of biomechanical energy conversion devices. In addition, the in vivo evaluation of the iTENG was demonstrated for over 72 h of implantation, during which the iTENG generated electricity continuously in the active animal. Due to its excellent in vivo performance, a self-powered wireless transmission system was fabricated for real-time wireless cardiac monitoring. Given its outstanding in vivo output and stability, iTENG can be applied not only to power implantable medical devices but also possibly to fabricate a self-powered, wireless healthcare monitoring system.
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Affiliation(s)
- Qiang Zheng
- Beijing Institute of Nanoenergy and Nanosystems, Chinese Academy of Sciences , National Center for Nanoscience and Technology (NCNST), Beijing 100083, China
| | - Hao Zhang
- Institute of Cardiothoracic Surgery at Changhai Hospital, Second Military Medical University , Shanghai 200433, China
| | - Bojing Shi
- Beijing Institute of Nanoenergy and Nanosystems, Chinese Academy of Sciences , National Center for Nanoscience and Technology (NCNST), Beijing 100083, China
| | - Xiang Xue
- Institute of Cardiothoracic Surgery at Changhai Hospital, Second Military Medical University , Shanghai 200433, China
| | - Zhuo Liu
- School of Biological Science and Medical Engineering, Beihang University , Beijing 100191, China
| | - Yiming Jin
- Beijing Institute of Nanoenergy and Nanosystems, Chinese Academy of Sciences , National Center for Nanoscience and Technology (NCNST), Beijing 100083, China
| | - Ye Ma
- Institute of Cardiothoracic Surgery at Changhai Hospital, Second Military Medical University , Shanghai 200433, China
| | - Yang Zou
- School of Biological Science and Medical Engineering, Beihang University , Beijing 100191, China
| | - Xinxin Wang
- Beijing Institute of Nanoenergy and Nanosystems, Chinese Academy of Sciences , National Center for Nanoscience and Technology (NCNST), Beijing 100083, China
| | - Zhao An
- Institute of Cardiothoracic Surgery at Changhai Hospital, Second Military Medical University , Shanghai 200433, China
| | - Wei Tang
- Beijing Institute of Nanoenergy and Nanosystems, Chinese Academy of Sciences , National Center for Nanoscience and Technology (NCNST), Beijing 100083, China
| | - Wei Zhang
- Institute of Cardiothoracic Surgery at Changhai Hospital, Second Military Medical University , Shanghai 200433, China
| | - Fan Yang
- Institute of Cardiothoracic Surgery at Changhai Hospital, Second Military Medical University , Shanghai 200433, China
| | - Yang Liu
- Institute of Cardiothoracic Surgery at Changhai Hospital, Second Military Medical University , Shanghai 200433, China
| | - Xilong Lang
- Institute of Cardiothoracic Surgery at Changhai Hospital, Second Military Medical University , Shanghai 200433, China
| | - Zhiyun Xu
- Institute of Cardiothoracic Surgery at Changhai Hospital, Second Military Medical University , Shanghai 200433, China
| | - Zhou Li
- Beijing Institute of Nanoenergy and Nanosystems, Chinese Academy of Sciences , National Center for Nanoscience and Technology (NCNST), Beijing 100083, China
| | - Zhong Lin Wang
- Beijing Institute of Nanoenergy and Nanosystems, Chinese Academy of Sciences , National Center for Nanoscience and Technology (NCNST), Beijing 100083, China
- School of Materials Science and Engineering, Georgia Institute of Technology , Atlanta, Georgia 30332-0245, United States
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Fakhro A, Jalalabadi F, Brown RH, Izaddoost SA. Treatment of Infected Cardiac Implantable Electronic Devices. Semin Plast Surg 2016; 30:60-5. [PMID: 27152097 DOI: 10.1055/s-0036-1580733] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
With their rising benefits, cardiac implantable electronic devices (CIEDs) such as pacemakers and left ventricular assist devices (LVADs) have witnessed a sharp rise in use over the past 50 years. As indications for use broaden, so too does their widespread employment with its attendant rise of CIED infections. Such large numbers of infections have inspired various algorithms mandating treatment. Early diagnosis of inciting organisms is crucial to tailoring appropriate antibiotic and or antifungal treatment. In addition, surgical debridement and explant of the device have been a longstanding modality of care. More novel therapies focus on salvage of the device by way of serial washouts and instilling drug-eluting antibiotic impregnated beads into the wound. The wound is then serially debrided until clean and closed. This technique is better suited to patients whose device cannot be removed, patients who are poor candidates for cardiac surgery, or patients who have failed conventional prior treatments.
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Affiliation(s)
- Abdulla Fakhro
- Division of Plastic and Reconstructive Surgery, Baylor College of Medicine, Houston, Texas
| | - Faryan Jalalabadi
- Division of Plastic and Reconstructive Surgery, Baylor College of Medicine, Houston, Texas
| | - Rodger H Brown
- Division of Plastic and Reconstructive Surgery, Baylor College of Medicine, Houston, Texas
| | - Shayan A Izaddoost
- Division of Plastic and Reconstructive Surgery, Baylor College of Medicine, Houston, Texas
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Sohail MR, Baddour LM. Role of PET Imaging in Management of Implantable Electronic Device Infection. JACC Cardiovasc Imaging 2016; 9:291-3. [PMID: 26897668 DOI: 10.1016/j.jcmg.2015.10.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 10/22/2015] [Indexed: 11/29/2022]
Affiliation(s)
- M Rizwan Sohail
- Divisions of Infectious Diseases and Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota.
| | - Larry M Baddour
- Divisions of Infectious Diseases and Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota
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Schwartzman D, Pasculle AW, Ceceris KD, Smith JD, Weiss LE, Campbell PG. An off-the-shelf plasma-based material to prevent pacemaker pocket infection. Biomaterials 2015; 60:1-8. [DOI: 10.1016/j.biomaterials.2015.04.042] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 04/17/2015] [Accepted: 04/21/2015] [Indexed: 12/18/2022]
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Inacio RC, Klautau GB, Murça MAS, da Silva CB, Nigro S, Rivetti LA, Pereira WL, Salles MJC. Microbial diagnosis of infection and colonization of cardiac implantable electronic devices by use of sonication. Int J Infect Dis 2015. [PMID: 26216762 DOI: 10.1016/j.ijid.2015.07.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES The clinical utility of sonication as an adjunctive diagnostic tool for the microbial diagnosis of cardiac implantable device-associated infections (CIDAIs) was investigated. METHODS The implants of 83 subjects were investigated, 15 with a CIDAI and 68 without a clinical infection. Clinical data were analyzed prospectively and sonication fluid cultures (83 patients, 100%) and traditional cultures (31 patients, 37.4%) were performed RESULTS Generator pocket infection and device-related endocarditis were found in 13 (86.7%) and four (26.7%) subjects, respectively. The mean numbers of previous technical complications and infections were higher in the infected patients compared to the non-infected patients (8 vs. 1, p<0.001; 2 vs. 0, p<0.031, respectively). The sensitivity and specificity for detecting CIDAI was 73.3% (11/15) and 48.5% (33/68) for sonication fluid culture, and 26.7% (4/15) and 100% (16/16) for traditional culture (p<0.001), respectively. A higher number of organisms were identified by sonication fluid than by tissue culture (58 vs. 4 specimens; p<0.001). The most frequent organisms cultured were Gram-positive cocci (66.1%), mainly coagulase-negative staphylococci (35.5%). Thirty-five (51.5%) non-infected subjects were considered colonized due to the positive identification of organisms exclusively through sonication fluid culture. CONCLUSIONS Sonication fluid culture from the removed cardiac implants has the potential to improve the microbiological diagnosis of CIDAIs.
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Affiliation(s)
| | - Giselle Burlamaqui Klautau
- Department of Internal Medicine, Division of Infectious Diseases, Santa Casa de São Paulo School of Medical Sciences, Rua Dr Cesáreo Mota Jr 112, CEP 01303-060, São Paulo, SP, Brazil
| | - Maria Aparecida S Murça
- Department of Laboratory Medicine and Pathology, Division of Infectious Diseases, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Cely Barreto da Silva
- Department of Laboratory Medicine and Pathology, Division of Infectious Diseases, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Stanley Nigro
- Department of Laboratory Medicine and Pathology, Division of Infectious Diseases, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Luiz Antonio Rivetti
- Department of Surgery, Division of Infectious Diseases, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Wilson Lopes Pereira
- Department of Surgery, Division of Infectious Diseases, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Mauro Jose Costa Salles
- Department of Internal Medicine, Division of Infectious Diseases, Santa Casa de São Paulo School of Medical Sciences, Rua Dr Cesáreo Mota Jr 112, CEP 01303-060, São Paulo, SP, Brazil.
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SHARIFF NASIR, EBY ELIZABETH, ADELSTEIN EVAN, JAIN SANDEEP, SHALABY ALAA, SABA SAMIR, WANG NORMANC, SCHWARTZMAN DAVID. Health and Economic Outcomes Associated with Use of an Antimicrobial Envelope as a Standard of Care for Cardiac Implantable Electronic Device Implantation. J Cardiovasc Electrophysiol 2015; 26:783-9. [DOI: 10.1111/jce.12684] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 03/20/2015] [Accepted: 03/27/2015] [Indexed: 11/30/2022]
Affiliation(s)
- NASIR SHARIFF
- Heart, Lung and Vascular Medicine Institute; University of Pittsburgh; Pittsburgh Pennsylvania USA
| | | | - EVAN ADELSTEIN
- Heart, Lung and Vascular Medicine Institute; University of Pittsburgh; Pittsburgh Pennsylvania USA
| | - SANDEEP JAIN
- Heart, Lung and Vascular Medicine Institute; University of Pittsburgh; Pittsburgh Pennsylvania USA
| | - ALAA SHALABY
- Pittsburgh Veterans Administration Healthcare System; Pittsburgh Pennsylvania USA
| | - SAMIR SABA
- Heart, Lung and Vascular Medicine Institute; University of Pittsburgh; Pittsburgh Pennsylvania USA
| | - NORMAN C. WANG
- Heart, Lung and Vascular Medicine Institute; University of Pittsburgh; Pittsburgh Pennsylvania USA
| | - DAVID SCHWARTZMAN
- Heart, Lung and Vascular Medicine Institute; University of Pittsburgh; Pittsburgh Pennsylvania USA
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Podoleanu C, Deharo JC. Management of Cardiac Implantable Electronic Device Infection. Arrhythm Electrophysiol Rev 2014; 3:184-9. [PMID: 26835089 DOI: 10.15420/aer.2014.3.3.184] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 09/22/2014] [Indexed: 01/12/2023] Open
Abstract
Despite improved preventive measures, infection associated with the use of cardiac implantable electronic devices (CIEDs) to treat often life-threatening conditions is rising at an average annual rate of almost 5 %. This rise is being driven by the increasing complexity of CIED technology and by the advancing age and co-morbidities of the patients. Although CIED infection is usually suspected based on local signs at the generator pocket site, diagnosis can be challenging in patients presenting no local manifestations or symptoms. Diagnostic methods include microbiological testing and echocardiography, and may be completed by positron emission tomography (PET)/computed tomography (CT) scan in selected cases. CIED infection requires a multidisciplinary approach in view of hardware extraction, targeted antibiotic therapy and reimplantation on an as-needed basis. Antibiotic prophylaxis targeting staphylococcal flora is recommended but the relation of these infections to medical care exposes patients to multi-resistant bacteria. New preventive measures utilising an antibacterial sleeve look promising. Treatment can be started on an empirical basis using an antistaphylococcal agent but must be continued using targeted antibiotic therapy. Crucial questions remain as to the best prevention strategy, optimal duration and timing of antibiotic therapy, and the most effective reimplantation technique.
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Affiliation(s)
- Cristian Podoleanu
- Cardiology Department, University of Medicine and Pharmacy Tîrgu Mures, Tîrgu Mures, Romania
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Sandoe JAT, Barlow G, Chambers JB, Gammage M, Guleri A, Howard P, Olson E, Perry JD, Prendergast BD, Spry MJ, Steeds RP, Tayebjee MH, Watkin R. Guidelines for the diagnosis, prevention and management of implantable cardiac electronic device infection. Report of a joint Working Party project on behalf of the British Society for Antimicrobial Chemotherapy (BSAC, host organization), British Heart Rhythm Society (BHRS), British Cardiovascular Society (BCS), British Heart Valve Society (BHVS) and British Society for Echocardiography (BSE). J Antimicrob Chemother 2014; 70:325-59. [PMID: 25355810 DOI: 10.1093/jac/dku383] [Citation(s) in RCA: 249] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Infections related to implantable cardiac electronic devices (ICEDs), including pacemakers, implantable cardiac defibrillators and cardiac resynchronization therapy devices, are increasing in incidence in the USA and are likely to increase in the UK, because more devices are being implanted. These devices have both intravascular and extravascular components and infection can involve the generator, device leads and native cardiac structures or various combinations. ICED infections can be life-threatening, particularly when associated with endocardial infection, and all-cause mortality of up to 35% has been reported. Like infective endocarditis, ICED infections can be difficult to diagnose and manage. This guideline aims to (i) improve the quality of care provided to patients with ICEDs, (ii) provide an educational resource for all relevant healthcare professionals, (iii) encourage a multidisciplinary approach to ICED infection management, (iv) promote a standardized approach to the diagnosis, management, surveillance and prevention of ICED infection through pragmatic evidence-rated recommendations, and (v) advise on future research projects/audit. The guideline is intended to assist in the clinical care of patients with suspected or confirmed ICED infection in the UK, to inform local infection prevention and treatment policies and guidelines and to be used in the development of educational and training material by the relevant professional societies. The questions covered by the guideline are presented at the beginning of each section.
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Affiliation(s)
| | - Gavin Barlow
- Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | | | | | | | - Philip Howard
- University of Leeds/Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ewan Olson
- Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | | | - Michael J Spry
- Countess of Chester Hospital NHS Foundation Trust, Chester, UK
| | - Richard P Steeds
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Greenspon AJ, Le KY, Prutkin JM, Sohail MR, Vikram HR, Baddour LM, Danik SB, Peacock J, Falces C, Miro JM, Naber C, Carrillo RG, Tseng CH, Uslan DZ. Influence of Vegetation Size on the Clinical Presentation and Outcome of Lead-Associated Endocarditis. JACC Cardiovasc Imaging 2014; 7:541-9. [DOI: 10.1016/j.jcmg.2014.01.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 01/23/2014] [Accepted: 01/31/2014] [Indexed: 10/25/2022]
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McGarry TJ, Joshi R, Kawata H, Patel J, Feld G, Birgersdotter-Green UM, Pretorius V. Pocket infections of cardiac implantable electronic devices treated by negative pressure wound therapy. ACTA ACUST UNITED AC 2013; 16:372-7. [DOI: 10.1093/europace/eut305] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Sonication of explanted cardiac implants improves microbial detection in cardiac device infections. J Clin Microbiol 2012. [PMID: 23196364 DOI: 10.1128/jcm.02230-12] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The sonication technique has been shown to be a promising tool for microbiological diagnosis of device-related infections. We evaluated the usefulness of the sonication method for pathogen detection in 80 explanted cardiac components collected from 40 patients, and the results were compared with those of conventional cultures. Forty subjects undergoing cardiac device removal were studied: 20 had cardiac device infection, and 20 subjects underwent elective generator replacement or revision in the absence of infection. Sonication of explanted devices was more sensitive than traditional culture for microbial detection (67% and 50%, respectively; P = 0.0005). The bacterial count detected in sonication fluid culture was significantly higher than that detected in traditional culture in both infected (P = 0.019) and uninfected (P = 0.029) devices. In the infected patients, sonication fluid culture yielded a significantly higher rate of pathogen detection in explanted electrodes than traditional culture (65% versus 45%; P = 0.02), while no differences were found in the generators. Ten strains were detected only through sonication fluid culture: 6 Staphylococcus epidermidis strains, 1 Staphylococcus hominis strain, 2 Corynebacterium striatum strains, and 1 Brevundimonas sp. Neither the type nor the duration of antimicrobial therapy before device removal had an effect on the diagnostic performance of sonication fluid culture (P = 0.75 and P = 0.56, respectively). In the patients without infection, sonication fluid culture was positive in 8 cases (40%), whereas conventional culture was positive in only 4 (20%). In summary, the sonication technique improves the microbiological diagnosis of explanted cardiac devices.
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Htwe TH, Khardori NM. Cardiac emergencies: infective endocarditis, pericarditis, and myocarditis. Med Clin North Am 2012; 96:1149-69. [PMID: 23102482 DOI: 10.1016/j.mcna.2012.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Cardiac infections presenting as emergencies include complications of infective endocarditis, including congestive heart failure, chordae tendinae rupture, cardiac arrhythmias, and embolic phenomenon; acute pericarditis, including cardiac tamponade; and acute myocarditis presenting with malignant cardiac arrhythmias or congestive heart failure. Most of these emergent infectious disease manifestations of the cardiovascular system have a good prognosis if diagnosed early and managed appropriately. Newer diagnostic modalities and combined treatment guidelines are available from the European Society of Cardiology and the American Heart Association.
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Affiliation(s)
- Tin Han Htwe
- Division of Infectious Diseases, Sentara Medical Group, Norfolk, VA 23502-3979, USA
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Pandit SV, Jalife J. Biological pacemakers: The oscillatory road ahead. Heart Rhythm 2012; 9:1319-20. [DOI: 10.1016/j.hrthm.2012.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Indexed: 11/27/2022]
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