cardiac device infection

infection of cardiovascular implantable electronic device 1) cardiac pacemaker 2) implantable cardioverter defibrillator (ICD) Etiology: 1) risk factors a) immunosuppression, including 1] renal insufficiency 2] diabetes mellitus 3] corticosteroid use b) oral anticoagulation use c) coexisting illness d) periprocedural factors, including 1] failure to administer perioperative antibiotic prophylaxis 2] preoperative fever 3] preprocedural temporary pacing e) device revision or replacement f) coexisting indwelling hardware g) operator inexperience 2) Staphylococcus sp (60-80%), roughly equal incidence of: a) Staphylococcus aureus b) coagulase-negative Staphylococcus Clinical manifestations: - device protrusion through the skin indicates that the entire device system is infected even in the absence of signs & symptoms of infection [2] Laboratory: - blood cultures (at least 2 sets) prior to initiating antibiotic therapy - gram stain & culture of generator pocket & lead tip Special laboratory: - transesophageal echocardiogram a) positive blood culture b) suspected endocarditis Management: - device removal may be avoided if infection is superficial & does not involve hardware - do not attempt aspiration of the device site [2] - 7 to 10 days of oral antistaphylococcal therapy if device does not need to be removed - complete removal of all hardware if any part of the device is infected followed by antibiotic therapy that covers Staphylococcus [2] - prevention: antibiotic prophylaxis with antibiotic that has activity against Staphylococci prior to device implantation

General

device infection; implant infection; stent infection

References

Baddour LM et al Update on cardiovascular implantable electronic device infections and their management: A scientific statement from the American Heart Association. Circulation 2010 Jan 26; 121:458. PMID: 20048212
Medical Knowledge Self Assessment Program (MKSAP) 16, 18 American College of Physicians, Philadelphia 2012, 2018.

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