Infectious complications of implantable cardiac devices: diagnosis, management and current guidelines

Abstract

Cardiac Implantable Electronic Devices (CIED) are common in modern practice. The CIED-prescribed population continues to increase and diversify, which has led to a rise in CIED-related infections. As technology advances, more tools are available for diagnosis. However, diagnosis and treatment for most infections is still guided by clinical presentation, blood culture, and TEE. Currently, the most common organism continues to be the Staphylococcus species. Resistant variants should be covered empirically and narrowed after 72 hours when cultures develop. Lack of accurate microbiology data results in longer courses of treatment, which affects the patient's quality of life, increases the cost, and has greater risk for side effects. Early involvement and follow-up with infectious diseases specialists may help to minimize complications.

Source control is imperative for treating the infection, and culturing of the infected hardware, will help to determine the choice and duration of antibiotic therapy. Extraction techniques for CIED systems will depend on the expertise of the specialist and should be individualized case-by-case. New techniques for extraction and implantation continue to emerge, in addition to new devices such as leadless pacemakers. These may have reduced risk of infection, however, data on infectious organisms, appropriate treatments, or extraction techniques for these new devices are limited.

Requirements for re-implantation should be evaluated for every case and temporary pacing is a viable option for patients who are pacemaker-dependent.

In this article, we will review the diagnosis and management of CIED-related infections as stated by current guidelines.

Conflict of interest. Dr. Michael Orlov has received a research grant from Boston Scientific, and is a consultant to Abbott and Boston Scientific, unrelated to the subject of this article.

For citation: Alpizar R.M., Fleisher J., Rex L., HonShideler C., Orlov M.V. Infectious complications of implantable cardiac devices: diagnosis, management and current guidelines. Infektsionnye bolezni: novosti, mneniya, obuchenie [Infectious Diseases: News, Opinions, Training]. 2020; 9 (3): 67-73. DOI: https://doi.org/l0.33029/2305-3496-2020-9-3-67-73

References

1. Greenspon A.J., et al. 16-year trends in the infection burden for pacemakers and implantable cardioverter-defibrillators in the United States. J Am Coll Cardiol. 2011; 58: 1001-6.

2. Raatikainen M.J.P, et al. Statistics on the use of cardiac electronic devices and electrophysiological procedures in the European Society of Cardiology countries: 2014 report from the European Heart Rhythm Association. Europace. 2015; 17: i1-75.

3. Ahsan S.Y., et al. A simple infection-control protocol to reduce serious cardiac device infections. Europace. 2014; 16: 1482-9.

4. Sohail M.R. Mortality and cost associated with cardiovascular implantable electronic device infections. Arch Intern Med. 2011; 171: 1821.

5. Habib G., et al. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC)Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J. 2015; 36: 3075-128.

6. Kusumoto F.M., et al. 2017 HRS expert consensus statement on cardiovascular implantable electronic device lead management and extraction. Heart Rhythm. 2017; 14: e503-51.

7. Klug D., et al. Risk factors related to infections of implanted pacemakers and cardioverter-defibrillators: results of a large prospective study. Circulation. 2007; 116: 1349-55.

8. Tarakji K.G., et al. Cardiac implantable electronic device infections: presentation, management, and patient outcomes. Heart Rhythm. 2010; 7: 1043-7.

9. Sekar P, et al. Comparative sensitivity of transthoracic and transesophageal echocardiography in diagnosis of infective endocarditis among veterans with Staphylococcus aureus bacteremia. Open Forum Infect. Dis. 2017; 4; ofx035.

10. Sarrazin J.-F, et al. Usefulness of fluorine-18 positron emission tomography/computed tomography for identification of cardiovascular implantable electronic device infections. J Am Coll Cardiol. 2012; 59: 161625.

11. Erba P.A., et al. Radiolabeled WBC scintigraphy in the diagnostic workup of patients with suspected device-related infections. JACC Cardio-vasc Imaging. 2013; 6: 1075-86.

12. Hussein A.A., et al. Microbiology of cardiac implantable electronic device infections. JACC Clin Electrophysiol. 2016; 2: 498-505.

13. Blomstrom-Lundqvist C., et al. 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). EP Europace. 2019; 2019: euz246. DOI: https://doi.org/10.1093/euro-pace/euz246

14. Sohail M.R., et al. Management and outcome of permanent pacemaker and implantable cardioverter-defibrillator infections. J Am Coll Cardiol. 2007; 49: 1851-9.

15. Peacock J.E., et al. Attempted salvage of infected cardiovascular implantable electronic devices: are there clinical factors that predict success? Pacing Clin Electrophysiol. 2018; 41: 524-31.

16. Tan E.M., et al. Outcomes in patients with cardiovascular implantable electronic device infection managed with chronic antibiotic suppression. Clin Infect Dis. 2017; 64: 1516-21.

17. Hasumi E., et al. Novel extraction technique of retained pacemaker and defibrillator lead during heart transplantation. PLoS One. 2018; 13: e0203172.

18. Liang J.J., et al. Low lateral thoracic site for cardiac implantable electronic device implantation: a viable alternative in patients with limited access options after infected device extraction. Heart Rhythm. 2017; 14: 1506-14.

19. Mountantonakis S.E., Tschabrunn C.M., Deyell M.W., Cooper J.M. Same-day contralateral implantation of a permanent device after lead extraction for isolated pocket infection. Europace. 2014; 16: 252-7.

20. Portillo M.E., Salvado M., Trampuz A., Siverio A., Alier A., Sorli L., et al. Improved diagnosis of orthopedic implant-associated infection by inoculation of sonication fluid into blood culture bottles. J Clin Microbiol. 2015; 53 (5): 1622-7.

CHIEF EDITOR
CHIEF EDITOR
Yushchuk Nikolay Dmitrievich
Academician of the Russian Academy of Sciences, Professor, head of the Infectious Diseases and Epidemiology Department, President of the Moscow State University of Medicine and Dentistry named after A.I. Evdokimov, Board member of the National Scientific Infectiologists? Society.

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