Cardiovascular implantable electronic device infection: Difference between revisions
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== Background == |
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* Ranges from local pocket infection to bacteremia to endocarditis |
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=== Epidemiology === |
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* Occurs in about 2 per 1000 device-years |
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== Clinical Manifestations == |
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* Isolated generator pocket infection: localized erythema, swelling, pain, tenderness, warmth, or drainage, with negative blood cultures |
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* Isolated pocket erosion: device or lead exposed through the skin, with or without signs of infection |
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* Lead infection: lead vegetation with positive blood cultures |
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==Investigations== |
==Investigations== |
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*Blood cultures |
*Blood cultures, ideally before antibiotics |
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*Transesophageal echocardiogram |
*Transesophageal echocardiogram in most cases (in strong preference to transthoracic echocardiogram) |
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*Pacemaker pocket swab at time of removal |
*Pacemaker pocket swab at time of removal |
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== |
== Management == |
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* Management depends on blood culture findings |
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** If positive, get TEE |
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** If negative but high clinical suspicion, get TEE |
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* If bacteremia or prior antibiotics |
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** Valve vegetation ± bacteremia: remove CIED and treat as endocarditis |
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** Lead vegetation ± bacteremia: remove CIED and treat for 2 weeks, or 4 weeks for [[Staphylococcus aureus]] |
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** Negative TEE: consider CIED removal depending on microbiology and treat for 2 weeks |
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* If no bacteremia but TEE positive, treat as above |
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* If no bacteremia and no TEE or TEE negative |
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** Pocket site infection or erosion: remove CIED and treat for 2 weeks |
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** No pocket site infection: monitor |
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* CIED can be reimplanted when blood cultures are negative for at least 72 hours |
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==Further Reading== |
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* |
*2017 HRS expert consensus statement on cardiovascular implantable electronic device lead management and extraction. ''Heart Rhythm''. 2017;14(12):e503-e551. doi: [https://doi.org/10.1016/j.hrthm.2017.09.001 10.1016/j.hrthm.2017.09.001] |
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[[Category:Infectious diseases]] |
[[Category:Infectious diseases]] |
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Revision as of 03:28, 30 July 2020
Background
- Ranges from local pocket infection to bacteremia to endocarditis
Epidemiology
- Occurs in about 2 per 1000 device-years
Clinical Manifestations
- Isolated generator pocket infection: localized erythema, swelling, pain, tenderness, warmth, or drainage, with negative blood cultures
- Isolated pocket erosion: device or lead exposed through the skin, with or without signs of infection
- Lead infection: lead vegetation with positive blood cultures
Investigations
- Blood cultures, ideally before antibiotics
- Transesophageal echocardiogram in most cases (in strong preference to transthoracic echocardiogram)
- Pacemaker pocket swab at time of removal
Management
- Management depends on blood culture findings
- If positive, get TEE
- If negative but high clinical suspicion, get TEE
- If bacteremia or prior antibiotics
- Valve vegetation ± bacteremia: remove CIED and treat as endocarditis
- Lead vegetation ± bacteremia: remove CIED and treat for 2 weeks, or 4 weeks for Staphylococcus aureus
- Negative TEE: consider CIED removal depending on microbiology and treat for 2 weeks
- If no bacteremia but TEE positive, treat as above
- If no bacteremia and no TEE or TEE negative
- Pocket site infection or erosion: remove CIED and treat for 2 weeks
- No pocket site infection: monitor
- CIED can be reimplanted when blood cultures are negative for at least 72 hours
Further Reading
- 2017 HRS expert consensus statement on cardiovascular implantable electronic device lead management and extraction. Heart Rhythm. 2017;14(12):e503-e551. doi: 10.1016/j.hrthm.2017.09.001
