Single center experience with cardiac device infection: Importance of periprocedural precautions
Single center experience with cardiac device infection: Importance of periprocedural precautions
Aim: Cardiac implantable electronic devices (CIED) have been increasingly used in recent years; consequently, there has been an increment in device-related complications. In this study, we aimed to make a recommendation to the centers that can implant cardiac devices about perioperative measures and to reinforce the role of perioperative measures in preventing cardiac device infection. Materials and Methods: The retrospective review examined the patients demographic data, medical diagnoses, operation details, echocardiographic findings, anticoagulant/ antiaggregant usement and complications (Table 1), laboratory findings and comorbidities (Table 2). No distinction was made between device types. A 90-day and a 30-day retrospective screening were performed. Patients were scheduled for follow-up visits one week and one month after the procedure. Three-month checks on telecommunication methods were performed. Results: The study included 169 people. There were 60 (35.5%) emergency department patients admitted. A pacemaker was implanted in 60 patients, an implantable cardioverter-defibrillator (ICD) in 79 patients, and a Cardiac Resynchronization Therapy (CRT) in 30 patients. The procedure time of patients with CRT implantation was significantly longer (p
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- 1. Athan E, Chu VH, Tattevin P et al. Clinical characteristics and outcome of infective endocarditis involving implantable cardiac devices. JAMA. 2012; 307:1727-35.
- 2. Harper MW, Uslan DZ, Greenspon A et al. "Clinical presentation of CIED infection following initial implant versus reoperation for generator change or lead addition." Open heart 5.1 (2018).
- 3. Branch-Elliman, W. A Roadmap for Reducing Cardiac Device Infections: a Review of Epidemiology, Pathogenesis, and Actionable Risk Factors to Guide the Development of an Infection Prevention Program for the Electrophysiology Laboratory. Curr Infect Dis Rep 19, 34 (2017). https://doi.org/10.1007/s11908- 017-0591-8.
- 4. Romeyer-Bouchard C, Costa A, Dauphinot V et al. Prevalence and risk factors related to infections of cardiac resynchronization therapy devices. Eur Heart J. 2010; 31:203-10.
- 5. Edelstein S, Yahalom M. Cardiac device-related endocarditis: epidemiology, pathogenesis, diagnosis, and treatment --- a review. Int J Angiol. 2009; 18:167-72.
- 6. Baddour LM, Epstein AE, Ericksonet CC et al. Update on cardiovascular implantable electronic device infections and their management: a scientific statement from the American Heart Association. Circulation. 2010; 121:458-77.
- 7. Tarakji KG, Wilkoff BL. How to diagnose and manage patients with cardiac implantable electronic device infections. J Arrhythm. 2013; 6:320-4.
- 8. Voigt A, Shalaby A, Saba S. Continued rise in rates of cardiovascular implantable electronic device infections in the United States:temporal trends and causative insights. Pacing Clin Electrophysiol 2010; 33:414–9.
- 9. Rohacek M,Weisser M, Kobza R et al. Bacterial colonization and infection of electrophysiological cardiac devices detected with sonication and swab culture. Circulation 2010; 121:1691–7.
- 10. Baddour LM, Epstein AE, Erickson CC et al. Update on cardiovascular implantable electronic device infections and their management: a scientific statement from the American Heart Association. Circulation 2010; 121:458–77.
- 11. Traykov V, Bongiorni MG, Boriani G et al. "Clinical practice and implementation of guidelines for the prevention, diagnosis and management of cardiac implantable electronic device infections: results of a worldwide survey under the auspices of the European Heart Rhythm Association." EP Europace 21.8 (2019): 1270-1279.
- 12. Rahman R, Saba S, Bazaz R et al. "Infection and readmission rate of cardiac implantable electronic device insertions: an observational single center study." American journal of infection control 44.3 (2016): 278-282.
- 13. Polyzos KA, Konstantelias AA, Falagas ME. "Risk factors for cardiac implantable electronic device infection: a systematic review and meta-analysis." Ep Europace 17.5 (2015): 767-777.
- 14. Birnie DH,Wang J, Alings M, Philippon F et al. "Risk factors for infections involving cardiac implanted electronic devices." Journal of the American College of Cardiology 74.23 (2019): 2845- 2854.
- 15. Barbar T, Patel R, Thomas G, Cheung JW. "Strategies to Prevent Cardiac Implantable Electronic Device Infection." The Journal of Innovations in Cardiac Rhythm Management 11.1 (2020): 3949.
- 16. Sandoe JA, Barlow G, Chambers JB et al. "Guidelines for the diagnosis, prevention and management of implantable cardiac electronic device infection. Report of a joint Working Party project on behalf of the British Society for Antimicrobial Chemotherapy (BSAC, host organization), British Heart Rhythm Society (BHRS), British Cardiovascular Society (BCS), British Heart Valve Society (BHVS) and British Society for Echocardiography (BSE)." Journal of Antimicrobial Chemotherapy 70.2 (2015): 325-359.
- 17. Harrison JL, Prendergast BD, Sandoe JA. "Guidelines for the diagnosis, management and prevention of implantable cardiac electronic device infection." (2015): 250-252.
- 18. Uslan DZ, Gleva MJ, Warren DK et al. Cardiovascular implantable electronic device replacement infections and prevention: results from the REPLACE Registry. Pacing Clin Electrophysiol 2012; 35: 81-7.
- 19. Tompkins C, Cheng A, Dalal D et al. Dual antiplatelet therapy and heparin “bridging” significantly increase the risk of bleeding complications after pacemaker or implantable cardioverterdefibrillator device implantation. J Am Coll Cardiol 2010; 55: 2376–82.
- 20. Kutinsky IB, Jarandilla R, Jewett M, Haines DE. Risk of hematoma complications after device implant in the clopidogrel era. Circ Arrhythm Electrophysiol 2010; 3: 312–8.
- 21. Li HK, Chen FC, Rea RF, et al. No increased bleeding events with continuation of oral anticoagulation therapy for patients undergoing cardiac device procedure. Pacing Clin Electrophysiol 2011; 34: 868–74.
- 22. Ostrowska, B., Gkiouzepas, S., Kurland, S. Et al (2021). Device infections related to cardiac resynchronization therapy in clinical practice-An analysis of its prevalence, risk factors and routine surveillance at a single center university hospital. Clinical cardiology, 44(6), 739–747.
- 23. Han, H. C., Hawkins, N. M., Pearman et al. (2021). Epidemiology of cardiac implantable electronic device infections: incidence and risk factors. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 23(23 Suppl 4), iv3–iv10.
- 24. Barbar T, Patel R, Thomas G, Cheung JW. "Strategies to Prevent Cardiac Implantable Electronic Device Infection." The Journal of Innovations in Cardiac Rhythm Management 11.1 (2020): 3949.
- 25. Mangram AJ, Horan TC, Pearson ML et al. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol. 1999;20(4):250–278; quiz 279–280.
- 26. Darouiche RO, Wall MJ Jr, Itani KM et al. Chlorhexidinealcohol versus povidone-iodine for surgical-site antisepsis. N Engl J Med. 2010;362(1):18–26.
- 27. Qintar M, Zardkoohi O, Hammadah M et al. The impact of changing antiseptic skin preparation agent used for cardiac implantable electronic device (CIED) procedures on the risk of infection. Pacing Clin Electrophysiol. 2015;38(2):240–246.