Cardiac Device Infection

From Anvita Health Wiki

Contents 1 Introduction 2 Etiology 3 Laboratory 4 Diagnostic-procedures 5 Management 6 More General Terms 7 References

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

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
• 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
• prevention: antibiotic prophylaxis with antibiotic that has activity against Staphylococci prior to device implantation

More General Terms

• infection (infectious disease)

References

1. 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: [1]

cardiac device infection