1
|
Kim H, Kim S, Park S, Kim S, Choi Y, Kim JY, Oh YS, Kim SH. Clinical impact of capsulectomy during cardiac implantable electronic device generator replacement: a prospective randomized trial. J Interv Card Electrophysiol 2024; 67:1211-1217. [PMID: 38374300 DOI: 10.1007/s10840-024-01765-3] [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] [Received: 10/04/2023] [Accepted: 01/30/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND The avascular capsule around the generator of the cardiac implantable electronic device (CIED) could be susceptible to bacterial colonization and source of infection. Capsulectomy during CIED generator replacement may be beneficial in preventing device infection, but there is a lack of evidence. METHODS This prospective randomized trial, conducted from December 2013 to December 2019, included 195 patients divided equally into two groups. In the intervention group (n = 97), capsule removal was performed on the floor of the pocket, while it was not performed in the control group (n = 98). In both groups, swab culture was performed in the pocket. The primary outcome was the occurrence of device infection requiring pocket revision. RESULTS A total of 195 patients were included (mean age 70.2 ± 13.6 years, 55.4% women), with an average follow-up period of 54.3 ± 28.9 months. Among 182 patients undergoing microbiological cultures of pockets, 19 (10.4%) were confirmed positive, and Staphylococcus species were identified most frequently. The primary outcome occurred in 4 (2.1%), and there was no significant difference between the two groups (3.1% vs. 1.0%, p = 0.606). Hematoma has occurred in 10 patients (3.1% vs. 7.1%, p = 0.338), one of them required wound revision. In multivariable analysis, the occurrence of hematoma was the only independent risk factor associated with device infection (HR 13.6, 95% CI 1.02-181.15, p = 0.048). CONCLUSIONS In this long-term prospective study, capsulectomy during the replacement of the generator did not reduce the incidence of device infection. There was no association between bacterial colonization in the capsule around the generator and CIED infection.
Collapse
Affiliation(s)
- Hwajung Kim
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Division of Cardiology, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Soohyun Kim
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Soyoon Park
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sunhwa Kim
- Division of Cardiology, Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of Korea
| | - Young Choi
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ju Youn Kim
- Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yong-Seog Oh
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung-Hwan Kim
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| |
Collapse
|
2
|
Osswald B. [Surgical basics of cardiac implantable electronic device implantation from skin incision through closure]. Herzschrittmacherther Elektrophysiol 2022; 33:476-482. [PMID: 36066608 DOI: 10.1007/s00399-022-00892-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 08/04/2022] [Indexed: 06/15/2023]
Abstract
Implantation of pacemakers is generally considered a "minor intervention". Younger colleagues obtain their skills from experienced ones; ideally not just over the course of one or two interventions under surveillance but until a certain level of confidence is achieved. In Germany, certification is still optional. The German Cardiology Society (DSC, "Deutsche Gesellschaft für Kardiologie") provides expertise courses to obtain basic knowledge of pacemaker therapy; the GCS/GSCVS has been offering certification modules since 2013 to acquire fundamental knowledge from experts and basic technical skills by simulator training. The present article illustrates the major aspects of pacemaker implantation procedures and some avoidable pitfalls.
Collapse
Affiliation(s)
- Brigitte Osswald
- Elektrophysiologisch Chirurgie, Medizinische Klinik I, Johanniter-Krankenhaus Duisburg-Rheinhausen, Kreuzacker 1-7, 47228, Duisburg, Deutschland.
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Sławek-Szmyt S, Araszkiewicz A, Grygier M, Szmyt K, Chmielewska-Michalak L, Seniuk W, Waśniewski M, Smukowski T, Lesiak M, Mitkowski P. Predictors of Long-Term Infections After Cardiac Implantable Electronic Device Surgery ― Utility of Novel PADIT and PACE DRAP Scores ―. Circ J 2020; 84:1754-1763. [DOI: 10.1253/circj.cj-20-0305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Marek Grygier
- 1st Department of Cardiology, Poznan University of Medical Sciences
| | - Krzysztof Szmyt
- Department of General, Endocrine and Gastrointestinal Oncology Surgery, Poznan University of Medical Sciences
| | | | - Wojciech Seniuk
- 1st Department of Cardiology, Poznan University of Medical Sciences
| | | | - Tomasz Smukowski
- 1st Department of Cardiology, Poznan University of Medical Sciences
| | - Maciej Lesiak
- 1st Department of Cardiology, Poznan University of Medical Sciences
| | | |
Collapse
|
5
|
Hong B, Winkel A, Ertl P, Stumpp SN, Schwabe K, Stiesch M, Krauss JK. Bacterial colonisation of suture material after routine neurosurgical procedures: relevance for wound infection. Acta Neurochir (Wien) 2018; 160:497-503. [PMID: 29189910 DOI: 10.1007/s00701-017-3404-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 11/13/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND Wound healing impairment is a serious problem in surgical disciplines which may be associated with chronic morbidity, increased cost and patient discomfort. Here we aimed to investigate the relevance of bacterial colonisation on suture material using polymerase chain reaction (PCR) to detect and taxonomically classify bacterial DNA in patients with and without wound healing problems after routine neurosurgical procedures. METHODS Repeat surgery was performed in 25 patients with wound healing impairment and in 38 patients with well-healed wounds. To determine the presence of bacteria, a 16S rDNA-based PCR detection method was applied. Fragments of 500 bp were amplified using universal primers which target hypervariable regions within the bacterial 16S rRNA gene. Amplicons were separated from each other by single-strand conformation polymorphism (SSCP) analysis, and finally classified using Sanger sequencing. RESULTS PCR/SSCP detected DNA of various bacteria species on suture material in 10/38 patients with well-healed wounds and in 12/25 patients with wound healing impairment including Staphylococcus aureus, Staphylococcus epidermidis, Propionibacterium acnes and Escherichia coli. Microbiological cultures showed bacterial growth in almost all patients with wound healing impairment and positive results in PCR/SSCP (10/12), while this was the case in only one patient with a well-healed wound (1/10). CONCLUSIONS Colonisation of suture material with bacteria occurs in a relevant portion of patients with and without wound healing impairment after routine neurosurgical procedures. Suture material may provide a nidus for bacteria and subsequent biofilm formation. Most likely, however, such colonisation of sutures is not a general primer for subsequent wound infection.
Collapse
Affiliation(s)
- Bujung Hong
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
| | - Andreas Winkel
- Department of Prosthetic Dentistry and Biomedical Material Science, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Philipp Ertl
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Sascha Nico Stumpp
- Department of Prosthetic Dentistry and Biomedical Material Science, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Kerstin Schwabe
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Meike Stiesch
- Department of Prosthetic Dentistry and Biomedical Material Science, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| |
Collapse
|
6
|
Azevedo AS, Almeida C, Melo LF, Azevedo NF. Impact of polymicrobial biofilms in catheter-associated urinary tract infections. Crit Rev Microbiol 2016; 43:423-439. [PMID: 28033847 DOI: 10.1080/1040841x.2016.1240656] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Recent reports have demonstrated that most biofilms involved in catheter-associated urinary tract infections are polymicrobial communities, with pathogenic microorganisms (e.g. Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae) and uncommon microorganisms (e.g. Delftia tsuruhatensis, Achromobacter xylosoxidans) frequently co-inhabiting the same urinary catheter. However, little is known about the interactions that occur between different microorganisms and how they impact biofilm formation and infection outcome. This lack of knowledge affects CAUTIs management as uncommon bacteria action can, for instance, influence the rate at which pathogens adhere and grow, as well as affect the overall biofilm resistance to antibiotics. Another relevant aspect is the understanding of factors that drive a single pathogenic bacterium to become prevalent in a polymicrobial community and subsequently cause infection. In this review, a general overview about the IMDs-associated biofilm infections is provided, with an emphasis on the pathophysiology and the microbiome composition of CAUTIs. Based on the available literature, it is clear that more research about the microbiome interaction, mechanisms of biofilm formation and of antimicrobial tolerance of the polymicrobial consortium are required to better understand and treat these infections.
Collapse
Affiliation(s)
- Andreia S Azevedo
- a Department of Chemical Engineering, Faculty of Engineering , Laboratory for Process Engineering, Environment, and Energy and Biotechnology Engineering (LEPABE), University of Porto , Porto , Portugal
| | - Carina Almeida
- a Department of Chemical Engineering, Faculty of Engineering , Laboratory for Process Engineering, Environment, and Energy and Biotechnology Engineering (LEPABE), University of Porto , Porto , Portugal.,b Institute for Biotechnology and Bioengineering (IBB), Centre of Biological Engineering, Universidade do Minho , Braga , Portugal
| | - Luís F Melo
- a Department of Chemical Engineering, Faculty of Engineering , Laboratory for Process Engineering, Environment, and Energy and Biotechnology Engineering (LEPABE), University of Porto , Porto , Portugal
| | - Nuno F Azevedo
- a Department of Chemical Engineering, Faculty of Engineering , Laboratory for Process Engineering, Environment, and Energy and Biotechnology Engineering (LEPABE), University of Porto , Porto , Portugal
| |
Collapse
|
7
|
|