cardiac device infection

Introduction

infection of cardiovascular implantable electronic device

• cardiac pacemaker
• implantable cardioverter defibrillator (ICD)

Etiology

• risk factors
  • immunosuppression, including
    • renal insufficiency
    • diabetes mellitus
    • corticosteroid use
  • oral anticoagulation use
  • coexisting illness
  • periprocedural factors, including
    • failure to administer perioperative antibiotic prophylaxis
    • preoperative fever
    • preprocedural temporary pacing
  • device revision or replacement
  • coexisting indwelling hardware
  • operator inexperience
• Staphylococcus sp (60-80%), roughly equal incidence of:
  • Staphylococcus aureus
  • 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

Laboratory

• blood cultures (at least 2 sets) prior to initiating antibiotic therapy
• gram stain & culture of generator pocket & lead tip

Diagnostic procedures

• transesophageal echocardiogram
  • positive blood culture
  • suspected endocarditis

Management

• device removal may be avoided if infection is superficial & does not involve hardware
• do not attempt aspiration of the device site
• 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
• prevention: antibiotic prophylaxis with antibiotic that has activity against Staphylococci prior to device implantation

More general terms

• device infection; implant infection; stent infection

Additional terms

• cardiovascular implantable electronic device (CIED)