Implantable cardiac electric device (ICED/CIED) infections: Difference between revisions
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* Infections of cardiac device pocket or lead |
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= Definition = |
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* Infection of cardiac device pocket or lead |
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* 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) |
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= Microbiology = |
== Microbiology == |
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* Gram-positive (70-90%) |
* Gram-positive (70-90%) |
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* Culture-negative (15%) |
* Culture-negative (15%) |
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= Classification = |
== Classification == |
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* Blood cultures positive |
* Blood cultures positive |
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** Lead erosion |
** Lead erosion |
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= Risk Factors = |
== Risk Factors == |
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* Number of prior procedures, including generator replacements |
* Number of prior procedures, including generator replacements |
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* Trauma |
* Trauma |
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= Pathophysiology = |
== Pathophysiology == |
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* 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'' |
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= Investigations = |
== Investigations == |
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* Labs |
* Labs |
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** Swab of generator pocket intraoperatively |
** Swab of generator pocket intraoperatively |
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= Management = |
== Management == |
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* '''SOURCE CONTROL''' |
* '''SOURCE CONTROL''' |
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* If lead erosion: 7-10 days of antibiotics |
* If lead erosion: 7-10 days of antibiotics |
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= Prognosis = |
== Prognosis == |
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* Mortality ranges from 0 to 35% |
* Mortality ranges from 0 to 35% |
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* CKD has worse prognosis |
* CKD has worse prognosis |
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= Further Reading = |
== Further Reading == |
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* 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. |
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Latest revision as of 15:20, 17 August 2019
- 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
- Staphylococci
- 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: Guidelines for the diagnosis, prevention and management of implantable cardiac electronic device infection. J Antimicrob Chemother, 2015;70(2):325–359.
