The Risk Factors for Cardiac Device Infections: Patient, Physician, Device, and Procedure

AbstractObjective:To implement a comprehensive infection control (IC) program for prevention of cardiac device-associated infections (CDIs).Design:Prospective before-after trial with 2 years of follow-up.Setting:A tertiary-care, university-affiliated medical center.Patients:A consecutive sample of all adults undergoing cardiac device implantation between 1997 and 2002.Intervention:An IC program was implemented during late 2001 and included staff education, preoperative modification of patient risk factors, intraoperative control of strict aseptic technique, surgical scrubbing and attire, control of environmental risk factors, optimization of antibiotic prophylaxis, postoperative wound care, and active surveillance. The clinical endpoint was CDI rates.Results:Between 1997 and 2000, there were 7 CDIs among 725 procedures (mean annual CDI incidence, 1%). During the first 9 months of 2001, there were 7 CDIs among 167 procedures (4.2%; P = .007): CDIs increased from 7 among 576 to 3 among 124 following pacemaker implantation (P = .39) and from 0 among 149 to 4 among 43 following cardioverter-defibrillator implantation (P = .002). Of the 14 CDIs, 5 involved superficial wounds, 7 involved deep wounds, and 2 involved endocarditis. Following intervention, there were no cases of CDI among 316 procedures during 24 months of follow-up (4.2% reduction; P = .0005).Conclusions:We observed a high CDI rate associated with substantial morbidity. IC measures had an impact on CDI. Although the relative weight of each measure in the prevention of CDI remains unknown, our results suggest that implementation of a comprehensive IC program is feasible and efficacious in this setting.

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A multicentre study of cardiac device implantation, arrhythmic burden and risk factors in Fabry cardiomyopathy

Molecular Genetics and Metabolism ◽

10.1016/j.ymgme.2018.12.384 ◽

2019 ◽

Vol 126 (2) ◽

pp. S148-S149

Author(s):

Ravi Vijapurapu ◽

Ana Jovanovic ◽

Nigel Wheeldon ◽

Abbasin Zegard ◽

William Bradlow ◽

...

Keyword(s):

Risk Factors ◽

Multicentre Study ◽

Cardiac Device ◽

Device Implantation

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Abstract 19958: Evaluation of Tricuspid Regurgitation (TR) Severity Prior to and after Device Extraction in Patients with Cardiac Device Infection

Circulation ◽

10.1161/circ.130.suppl_2.19958 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Thomas Butler ◽

Akhlaq Khan ◽

Abhishek Sengupta ◽

Jonathan Sherman ◽

Russell Denman ◽

...

Keyword(s):

Risk Factors ◽

Tricuspid Regurgitation ◽

P Value ◽

Cardiac Device ◽

Clinical Complications ◽

Device Infection ◽

The Mean ◽

Device Extraction ◽

The Impact

Aim: This study sought to evaluate the impact of device extraction on the severity of TR in patients with cardiac device related infection (CDI) and infective endocarditis (CDRIE). Methods: The medical and echocardiographic records of 142 patients who had undergone device extraction for suspected infection from 2007 - 2013 were reviewed. Data on clinical complications, echocardiographic documentation of TR severity prior to and after device removal and potential risk factors for change in TR severity was obtained. A paired t test was used to evaluate whether the TR mean grade changed significantly. Patient Demographics: A total of 56 patients out of the 142 patients had TTE and/or TOE imaging. Of these patients, 22 patients had ICD’s, 27 patients had PPM’s and 7 patients had BiV Devices. The mean age was 62 years (47 males). Clinical complications included decompensated heart failure (12.5%), septic shock (8.9%), septic arthritis (8.9%), splenic abscess (1.78%), septic pulmonary embolism (5.35%), leukocytoclastic vasculitis (1.78%). Results: The mean duration of device in situ prior to extraction was 64 months (5.33yrs). The mean grade of TR prior to device extraction was grade 1.35/4 (SD=0.901, C.I. 1.16 to 1.72). The mean grade of TR post extraction was 1.54/4 (SD= 0.96 with C.I. 1.26 to 1.89). The mean difference in mean TR grade was 0.13 (C.I. 0.37 to -0.106) p >0.05. One patient had a worsening of TR by at least 2 grades post extraction. This was due to valve perforation from infection rather than extraction related trauma. This was the only patient that required surgery for clinically significant TR. Risk factors for worsening TR post extraction included the length of time leads were in situ and age of the patient. Time of Device in situ prior to extraction did not correlate significantly with severity of TR post procedure rho 0.12 (p value = 0.45). Furthermore, age at the time of the procedure did not correlate with tricuspid regurgitation severity post extraction rho 0.21 (p value = 0.18). Conclusions: Worsening of TR post extraction is uncommon and is more likely due to valve destruction from infection rather than trauma to the valve during extraction. Furthermore, a number of complications occur peri-procedurally that impacts on patient outcomes.

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Risk factors of cardiac device infection: Glove contamination during device procedures

American Journal of Infection Control ◽

10.1016/j.ajic.2017.03.019 ◽

2017 ◽

Vol 45 (8) ◽

pp. 866-871 ◽

Cited By ~ 4

Author(s):

Isabella Kozon ◽

Sam Riahi ◽

Søren Lundbye-Christensen ◽

Anna Margrethe Thøgersen ◽

Tove Ejlertsen ◽

...

Keyword(s):

Risk Factors ◽

Cardiac Device ◽

Device Infection ◽

Cardiac Device Infection

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Incidence of and risk factors for infectious complications in patients with cardiac device implantation

International Journal of Infectious Diseases ◽

10.1016/j.ijid.2015.05.011 ◽

2015 ◽

Vol 36 ◽

pp. 9-14 ◽

Cited By ~ 8

Author(s):

Hea Won Ann ◽

Jin Young Ahn ◽

Yong Duk Jeon ◽

In Young Jung ◽

Su Jin Jeong ◽

...

Keyword(s):

Risk Factors ◽

Infectious Complications ◽

Cardiac Device ◽

Device Implantation

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Hemopericardium with subsequent cardiac tamponade secondary to rivaroxaban treatment: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa482 ◽

2020 ◽

Author(s):

Pinang Shastri ◽

Sapan Bhuta ◽

Carson Oostra ◽

Todd Monroe

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Venous Thromboembolism ◽

Cardiac Tamponade ◽

Vitamin K Antagonists ◽

Oral Anticoagulants ◽

Factor Xa ◽

Thromboembolism Prophylaxis ◽

Cardiac Device ◽

Large Pericardial Effusion

Abstract Background The use and utility of novel oral anticoagulants has been increasing in clinical practice due to their relatively lower incidence of side effects such as intracranial haemorrhage, particularly in the elderly, when compared with vitamin K antagonists. Rivaroxaban is a factor Xa and prothrombinase inhibitor indicated for stroke and venous thromboembolism prophylaxis in non-valvular atrial fibrillation as well as treatment of venous thromboembolism. Case summary A patient with history of paroxysmal atrial fibrillation on Rivaroxaban presented with generalized malaise, lightheadedness, and dizziness. The patient was found to be in profound cardiogenic shock despite unremarkable cardiac enzymes. Electrocardiogram revealed rate controlled atrial fibrillation and T-wave inversions in the inferolateral leads without associated electrical alternans. Bedside echocardiogram revealed a large pericardial effusion consistent with cardiac tamponade physiology. Following anticoagulation reversal, the patient underwent urgent pericardiocentesis yielding haemorrhagic fluid, with subsequent improvement in haemodynamic status. Despite the presence of retroperitoneal lymphadenopathy on previous computed tomography of the abdomen and concern for underlying malignant effusion secondary to lymphoma, cytology of the fluid revealed no evidence of malignant cells and follow-up flow cytometry and bone marrow biopsy were unremarkable. Discussion While hemopericardium is not listed as a known side effect of Rivaroxaban, previous cases of hemopericardium secondary to Rivaroxaban have been described in the literature secondary to pre-disposing risk factors including CYP450 drug interactions or cardiac device implantations. In this case, the patient experienced a spontaneous hemopericardium on Rivaroxaban without any previously elucidated risk factors or evidence of malignancy.

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Implantable Cardiac Device Infections Prevalence: Diagnostic and Therapeutic Implications

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2021.6866 ◽

2021 ◽

Vol 9 (B) ◽

pp. 909-916

Author(s):

Hend Yahia ◽

Abdo Alazab ◽

Randa Aly ◽

Sameh Elmaraghi ◽

Ashraf Andraos

Keyword(s):

Risk Factors ◽

Mortality Rate ◽

Infection Rate ◽

High Rate ◽

Cardiac Resynchronization ◽

Entire System ◽

Cardiac Device ◽

Mortality And Morbidity ◽

Cardiac Resynchronization Therapy Devices ◽

Pocket Infection

Background: It has been demonstrated that the use of cardiac implanted electronic devices (CIED) improve mortality and survivability in a variety of patient populations. Nevertheless, CIED related infection is a serious complication characterized by a high rate of mortality and morbidity. Objectives: To evaluate the prevalence of CIED related infections, risk factors, clinical and demographic characteristics, causative organisms, and the management and outcome of patients presented in the Critical Care Department, Cairo University. Methods: A retrospective analysis was conducted in 1871 individuals who had been implanted with a cardiac device with a total number of devices of 1968 and 2270 procedures performed from January 2007 to December 2017. Results: 59 infectious episodes were identified with an estimated incidence of 2.99% of inserted devices and 2.6% of total procedures. The infection rate was considerably higher in patients with multiple procedures than those who had a single procedure (9.27% vs. 1.18%; P<0.001). The individuals with a dual-chamber implantable cardiac defibrillator (ICD) and cardiac resynchronization therapy devices (CRTD) had the highest infection rate of 6.25% & 6.85%, respectively. The rate of pocket infection (PI) and CIED related endocarditis (CDE) was 1.54% & 1.06% of total devices respectively. Numerous risk factors have been found; the most significant of those are diabetes mellitus, recurrent procedures, the device's complexity, and the existence of more than one lead. Gram-positive cocci were the most isolated organisms in all positive cultures (69.23%). Echocardiography revealed lead vegetations and valvular vegetations in 22 patients and 2 patients respectively. In 53 cases (89.83%), the devices were removed; in 41 cases, the entire system was removed; and in 12 cases, only the generator was removed. The mortality rate was found to be 10.17%, having a considerably higher prevalence in CDE individuals than in pocket infection individuals (20.83% vs. 2.86%; P=0.025). Conclusion: In our center, while the rate of CIED implantation continues to increase, the incidence rate of CIED-related infection continues to decline. Until now, the infection burden associated with secondary intervention is still significantly high. The management strategy of selection is to eliminate the entire system for patients presented with infection especially those with CDE. However, the mortality rate is still high.

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