View source for Implantable cardiac electric device (ICED/CIED) infections

* Infections of cardiac device pocket or lead
* Includes implantable cardiac defibrillators (ICDs) and cardiac resynchronization therapy devices(CRTDs) in addition to permanent pacemakers (PPMs)

== Microbiology ==

* Gram-positive (70-90%)
** Staphylococci
*** ''S. aureus''
*** Coagulase-negative staphylococci, especially for pocket infections
** Enterococci, viridans group streptococci, and ''S. pneumoniae''
** ''Cutibacterium acnes''
* Gram-negative (15-20%)
** ''Klebsiella'' and ''Serratia''
* Fungal (1%)
* Culture-negative (15%)

== Classification ==

* Blood cultures positive
** TEE positive: lead infection, infective endocarditis
** TEE negative: not infected, I guess?
* Blood cultures negative
** Pocket site infection
** Lead erosion

== Risk Factors ==

* Number of prior procedures, including generator replacements
* Lack of antimicrobial prophylaxis at the time of procedure
* &quot;Pickers&quot; at the pocket site
* Diabetes mellitus
* More than two leads
* Rapid weight loss
* Shallow pocket
* Trauma

== Pathophysiology ==

* Infection may be acquired in a number of ways:
** Device manufacturing
** During procedure
** Surgical site infection
** Hematogenous seeding
** Erosion through skin
* Asymptomatic colonization of the device and leads is common, and can develop into infection later on
** Most common organisms were coagulase-negative staphylococci and ''Cutibacterium''

== Investigations ==

* Labs
** Blood cultures
** TEE if blood cultures positive
** Swab of generator pocket intraoperatively

== Management ==

* '''SOURCE CONTROL'''
** Get intraoperative pocket swab, if possible
* If infective endocarditis, treat per guidelines
* If lead infection (BCx pos/TEE neg)
** Uncomplicated: 2 weeks of antibiotics
** Complicated: 4-6 weeks of antibiotics
* If pocket site infection:
** Swab positive: 10-14 days of antibiotics
** Swab negative: 7-10 days of antibiotics
* If lead erosion: 7-10 days of antibiotics

== Prognosis ==

* Mortality ranges from 0 to 35%
* CKD has worse prognosis

== Further Reading ==

* European guidelines: [https://doi.org/10.1093/jac/dku383 Guidelines for the diagnosis, prevention and management of implantable cardiac electronic device infection]. ''J Antimicrob Chemother'', 2015;70(2):325–359.

[[Category:Cardiac infections]]