Implantable cardiac electric device (ICED/CIED) infections - Revision history

Aidan at 15:20, 17 August 2019

2019-08-17T15:20:17Z

← Older revision		Revision as of 15:20, 17 August 2019
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		⚫	* Infections of cardiac device pocket or lead
	= Definition =

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

	= Microbiology =		== Microbiology ==

	* Gram-positive (70-90%)		* Gram-positive (70-90%)
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	* Culture-negative (15%)		* Culture-negative (15%)

	= Classification =		== Classification ==

	* Blood cultures positive		* Blood cultures positive
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	** Lead erosion		** Lead erosion

	= Risk Factors =		== Risk Factors ==

	* Number of prior procedures, including generator replacements		* Number of prior procedures, including generator replacements
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	* Trauma		* Trauma

	= Pathophysiology =		== Pathophysiology ==

	* Infection may be acquired in a number of ways:		* Infection may be acquired in a number of ways:
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	** Most common organisms were coagulase-negative staphylococci and ''Cutibacterium''		** Most common organisms were coagulase-negative staphylococci and ''Cutibacterium''

	= Investigations =		== Investigations ==

	* Labs		* Labs
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	** Swab of generator pocket intraoperatively		** Swab of generator pocket intraoperatively

	= Management =		== Management ==

	* '''SOURCE CONTROL'''		* '''SOURCE CONTROL'''
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	* If lead erosion: 7-10 days of antibiotics		* If lead erosion: 7-10 days of antibiotics

	= Prognosis =		== Prognosis ==

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

	= Further Reading =		== 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.		* 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.

Aidan: /* Implantable cardiac electric device (ICED) infections */

2019-08-13T11:46:26Z

Implantable cardiac electric device (ICED) infections

← Older revision		Revision as of 11:46, 13 August 2019
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	= Implantable cardiac electric device (ICED) infections =

	= Definition =		= Definition =

Aidan: Aidan moved page CIED Implantable cardiac electric device (ICED) infections to Implantable cardiac electric device (ICED/CIED) infections without leaving a redirect

2019-08-13T11:46:15Z

Aidan moved page CIED Implantable cardiac electric device (ICED) infections to Implantable cardiac electric device (ICED/CIED) infections without leaving a redirect

← Older revision		Revision as of 11:46, 13 August 2019
(No difference)

Aidan at 11:45, 13 August 2019

2019-08-13T11:45:59Z

← Older revision		Revision as of 11:45, 13 August 2019
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	= Implantable cardiac electric device (ICED) infections =		= Implantable cardiac electric device (ICED) infections =

	== Definition ==		= Definition =

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

	== Microbiology ==		= Microbiology =

	* Gram-positive (70-90%)		* Gram-positive (70-90%)
Line 19:		Line 19:
	* Culture-negative (15%)		* Culture-negative (15%)

	== Classification ==		= Classification =

	* Blood cultures positive		* Blood cultures positive
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	** Lead erosion		** Lead erosion

	== Risk Factors ==		= Risk Factors =

	* Number of prior procedures, including generator replacements		* Number of prior procedures, including generator replacements
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	* Trauma		* Trauma

	== Pathophysiology ==		= Pathophysiology =

	* Infection may be acquired in a number of ways:		* Infection may be acquired in a number of ways:
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	** Most common organisms were coagulase-negative staphylococci and ''Cutibacterium''		** Most common organisms were coagulase-negative staphylococci and ''Cutibacterium''

	== Investigations ==		= Investigations =

	* Labs		* Labs
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	** Swab of generator pocket intraoperatively		** Swab of generator pocket intraoperatively

	== Management ==		= Management =

	* '''SOURCE CONTROL'''		* '''SOURCE CONTROL'''
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	* If lead erosion: 7-10 days of antibiotics		* If lead erosion: 7-10 days of antibiotics

	== Prognosis ==		= Prognosis =

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

	== Further Reading ==		= 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.		* 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]]

Maintenance script: Imported from text file

2019-08-11T18:05:50Z

Imported from text file

New page

= Implantable cardiac electric device (ICED) infections =

== Definition ==

* Infection 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
* "Pickers" 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.