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


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:


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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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