Cardiac device-related endocarditis

Cardiac Device ◽

Prolonged Antibiotic Therapy ◽

Definite Treatment

Infection of cardiac implantable electronic devices is a severe disease associated with high mortality. Coagulase-negative staphylococci account for 70% of cases. Definite cardiac device-related infective endocarditis (CDRIE) diagnosis is particularly difficult and echocardiography and blood cultures are the cornerstones of diagnosis. Prognosis is poor and a definite treatment is mandatory. CDRIE must be treated by prolonged antibiotic therapy and complete device removal. Transvenous lead extraction is the gold standard, also in the presence of large vegetations. After extraction, the indication to reimplantation has to be reconsidered carefully and immediate reimplantation should be avoided.

Lead-Related Infective Endocarditis in Latvia: A Single Centre Experience

Medicina ◽

10.3390/medicina55090566 ◽

2019 ◽

Vol 55 (9) ◽

pp. 566

Author(s):

Nesterovics ◽

Stradins ◽

Kalejs ◽

Ansabergs ◽

...

Keyword(s):

Infective Endocarditis ◽

Electronic Devices ◽

Positive Culture ◽

Major Complication ◽

Heart Rhythm ◽

University Hospital ◽

Lead Extraction ◽

Common Location

Background and Objectives: Over the last five decades cardiac implantable electronic devices (CIED) have become established as the mainstay for the treatment of permanent bradycardias, chronic heart failure and dangerous heart rhythm disturbances. These devices improve survival and quality of life in many patients. However, infections associated with CIED implantation, particularly lead-related infective endocarditis (LRIE), can offset all benefits and make more harm than good for the patient. To date, there are no other studies in Latvia, addressing patients with lead-related infective endocarditis. The objective of this study was to identify the most common pathogens associated with LRIE and their antimicrobial resistance and to identify possible risk factors of patients who present with LRIE. Materials and Methods: The study was performed retrospectively at Pauls Stradins Clinical University Hospital (PSCUH). The study included patients who were referred to PSCUH due to LRIE for lead extraction. Patients were identified from procedural journals. Information about isolated microorganisms, patient comorbidities and visual diagnostics data was taken from patient records. Results: Forty-nine patients with CIED related infective endocarditis were included in the study, 34 (69.4%) were male, median age of all patients was 65.0 (50.5–73.0) years, median hospital stay was 15.5 (22.0–30.5) days. Successful and complete lead extraction was achieved in all patients. Thirty-two (65.3%) had received antibiotics prior to blood sample. Only in 31 (63.3%) positive culture results were seen. The most common isolated pathogens were Staphylococcus aureus (23.5%) and coagulase negative staphylococci (23.5%). Other bacteria were isolated considerably less often. The atrial lead was most common location for lead vegetations, seen in 50.0% of cases. Five (10.2%) patients have died due to the disease. Conclusions: Lead-related infective endocarditis is a major complication of cardiac implantable electronic devices with considerable morbidity and mortality, which in our study was as high as 10.2%.

Cardiac Implantable Electronic Device Lead Extractions

Cardiac Anesthesia: A Problem-Based Learning Approach ◽

10.1093/med/9780190884512.003.0022 ◽

2019 ◽

pp. 207-214

Author(s):

Kevin Fitzmartin ◽

Aalok Kacha

Keyword(s):

Standard Method ◽

Gold Standard ◽

Older Patients ◽

Electronic Device ◽

Electronic Devices ◽

Lead Extraction ◽

Lead Removal ◽

Gold Standard Method ◽

Device Extraction

Cardiac implantable electronic devices (CIEDs) are used for an increasing range of indications. With a broader range of indications, CIEDs are being implanted in increasing numbers. They are being used in older patients as well as patients with more comorbidities. As expected with these trends, the need for device extraction for a variety of reasons has steadily grown as well. These leads can often be removed via simple traction, but other techniques have been developed for circumstances where removal is more complex. To perform this procedure safely, a team-based approach is required, as is the ability to anticipate consequences of complications for each of the different methods of removal. A gold standard method has not been identified for transvenous lead extraction, but rather one has a toolbox of methods at their disposal. In this chapter, indications for lead removal, extraction techniques and devices, as well as potential complications are reviewed.

A Historical Perspective of Cardiac Implantable Electronic Device Infection: How a Menace Can Drive Technological and Clinical Improvement

Hearts ◽

10.3390/hearts2020016 ◽

2021 ◽

Vol 2 (2) ◽

pp. 202-212

Author(s):

Giulia Massaro ◽

Igor Diemberger ◽

Matteo Ziacchi ◽

Andrea Angeletti ◽

Giovanni Statuto ◽

...

Keyword(s):

Electronic Device ◽

Positive Impact ◽

Delayed Diagnosis ◽

Implantation Rate ◽

Major Complication ◽

Lead Extraction ◽

Device Infection ◽

New Perspective ◽

Poor Outcomes

In recent decades there has been a relevant increase in the implantation rate of cardiac implantable electronic devices (CIEDs), albeit with relevant geographical inhomogeneities. Despite the positive impact on clinical outcomes, the possibility of major complications is not negligible, particularly with respect to CIED infections. CIED infections significantly affect morbidity and mortality, especially in instances of delayed diagnosis and appropriate treatment. In the present review, we will start to depict the factors underlying the development of CIED infection as well as the difficulties related to its diagnosis and treatment. We will explain the reasons underlying the need to focus on prophylaxis rather than treatment, in view of the poor outcomes despite improvements in lead extraction procedures. This will lead to the consideration of management of this complication in a hub-spoke manner, and to our analysis of the several technological and procedural improvements developed to minimize this complication. These include prolongation of CIED longevity, the development of leadless devices, and integrated prophylactic approaches. We will conclude with a discussion regarding new devices and strategies under development. This complete excursus will provide the reader with a new perspective on how a major complication can drive technological improvements.

577. Incidence and Outcomes of Positive Outpatient Surveillance Blood Cultures in Hematopoietic Stem Cell Transplant (HSCT) Patients with Graft Versus Host Disease (GvHD) On High Dose ≥ 0.5 mg/kg/day (HD) and Low Dose < 0.5mg/kg/day (LD) Steroid Therapy

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.771 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S353-S354

Author(s):

Sarah Perreault ◽

Molly Schiffer ◽

Jennifer Zhao ◽

Dayna McManus ◽

Francine Foss ◽

...

Keyword(s):

Steroid Therapy ◽

Central Line ◽

Blood Cultures ◽

High Dose ◽

Cell Transplant ◽

Hematopoietic Stem ◽

Surveillance Cultures ◽

Number Of Patients ◽

Clinically Significant

Abstract Background Treatment of GvHD with steroids increases the risk of infection in HSCT patients due to additive immunosuppression and may delay the diagnosis of infection due to lack of symptoms. Outpatient surveillance blood cultures in HSCT with GvHD being treated with HD steroids has demonstrated a blood culture positivity rate of 3.5%. Currently, the utility of surveillance cultures in patients receiving LD steroid therapy is unknown. Our practice includes weekly outpatient surveillance cultures for all GvHD patients treated with steroids regardless of the dose. The primary endpoint of this study was to assess the incidence of positive surveillance blood cultures in GvHD patients receiving HD or LD steroids. Secondary endpoints included number of patients treated, hospitalization, 30 day mortality due to infection, and organisms isolated. Methods This was a single-center, retrospective review of GvHD patients at Yale New Haven Hospital between January 2013 and May 2019. Patients were excluded if: lack of signs or symptoms of GvHD, treatment with steroids for any indication other than GvHD, and active GvHD without central line. Cultures from patients receiving antibiotics for concurrent infection were also excluded. Results A total of 71 patients met criteria with 901 blood cultures. On HD, eight patients (14%) had 12 positive cultures (4%), and on LD, 16 patients (25%) had 22 positive cultures (4%) (p=0.15). Treatment occurred in six patients (75%) with four (24%) requiring hospitalization on HD, and 12 patients (75%) with 10 (83%) requiring hospitalization on LD (p=0.45). The median duration of steroid therapy was 93 and 236 days with a median dose of steroids of 1mg/kg/day and 0.15mg/kg/day, respectively. The number of positive cultures/1000 steroid days was 1.2 on HD and 0.5 on LD (RR 2.2). 30 day mortality was only noted in one patient (8%) on LD. The most common organism in both groups was Coagulase-negative staphylococci with all six cultures on HD classified as contaminants and 6/10 cultures requiring treatment on LD. Conclusion Although the relative risk of positive surveillance blood cultures in HD patients compared to LD was twofold higher, there were clinically significant infections identified in the LD group. Disclosures All Authors: No reported disclosures

Cardiovascular Implantable Electronic Device

CARDIOVASCULAR IMPLANTABLE ELECTRONIC DEVICE REMOVAL IN A PATIENT WITH NEGATIVE BLOOD CULTURES AT A HIGH RISK FOR ENDOCARDITIS

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(21)03700-1 ◽

2021 ◽

Vol 77 (18) ◽

pp. 2345

Author(s):

Rhythm Vasudeva ◽

Patrick Ters ◽

Richard Muraga ◽

Donna Sweet

Keyword(s):

High Risk ◽

Electronic Device ◽

Blood Cultures ◽

Device Removal ◽

Comparing clinical and microbiological methods for the diagnosis of true bacteraemia among patients with multiple blood cultures positive for coagulase-negative staphylococci

Clinical Microbiology and Infection ◽

10.1111/j.1469-0691.2010.03372.x ◽

2011 ◽

Vol 17 (4) ◽

pp. 569-571 ◽

Cited By ~ 18

Author(s):

I. Al Wohoush ◽

J. Rivera ◽

J. Cairo ◽

R. Hachem ◽

I. Raad

Keyword(s):

Blood Cultures ◽

Microbiological Methods ◽

Multiple Blood

Uniportal Video-Assisted Thoracotomy during Excimer Laser-Guided Cardiac Implantable Electronic Devices Lead Extraction: A 5-Year Single-Centre Experience

10.1055/s-0041-1725712 ◽

2021 ◽

Author(s):

M. Wacker ◽

L. Thewes ◽

A. Lux ◽

H. Busk ◽

M. Scherner ◽

...

Keyword(s):

Excimer Laser ◽

Electronic Devices ◽

Lead Extraction ◽

Single Centre ◽

Video Assisted ◽

Single Centre Experience

Distinguishing Sepsis From Blood Culture Contamination in Young Infants With Blood Cultures Growing Coagulase-Negative Staphylococci

PEDIATRICS ◽

10.1542/peds.86.2.157 ◽

1990 ◽

Vol 86 (2) ◽

pp. 157-162

Author(s):

Joseph W. St Geme ◽

Louis M. Bell ◽

Stephen Baumgart ◽

Carl T. D'Angio ◽

Mary Catherine Harris

Keyword(s):

Blood Culture ◽

Peripheral Blood ◽

Clinical Information ◽

Study Groups ◽

Blood Cultures ◽

High Risk Population ◽

Peripheral Blood Culture ◽

Young Infants ◽

Initial Culture

Coagulase-negative staphylococci represent the most common cause of serious nosocomial infection in many intensive care nurseries. However, these organisms are also common blood culture contaminants. To determine the value of quantitative blood cultures in distinguishing sepsis from culture contamination, we reviewed records of all infants in our nurseries who had peripheral blood isolates of coagulase-negative staphylococci during a 3-year period. Twenty-three episodes of sepsis were identified in 21 infants, and 10 infants had blood culture contamination. Colony counts from the initial peripheral blood culture were significantly different for the two study groups (P < .001). In 9 of 23 episodes of sepsis, the initial peripheral blood culture grew >100 colony-forming units (cfu) per mL. In the other 14 episodes, the initial culture yielded ≤50 cfu/mL. All 10 infants with culture contamination had colony counts of <50 cfu/mL, and in 9 the initial peripheral blood culture grew <20 cfu/mL. Infants with sepsis, including those with colony counts of ≤50 cfu/mL, were significantly more likely to have a central catheter or an abnormal hematologic value or both (P < .05). Infants who lacked these clinical features were more likely to have contamination. We conclude that quantitative blood cultures in conjunction with specific clinical information may distinguish sepsis from culture contamination with coagluase-negative staphylococci in young infants. In addition, low colony-count growth should not be ignored as contamination in this high-risk population.

Clinic Time Required for Remote and In-person Management of Cardiac Device Patients: A Time and Motion Workflow Evaluation (Preprint)

10.2196/preprints.27720 ◽

2021 ◽

Author(s):

David Lanctin ◽

Eliana Biundo ◽

Marco Di Bacco ◽

Sarah Rosemas ◽

Emmanuelle Nicolle ◽

...

Keyword(s):

Patient Management ◽

Clinic Visit ◽

Future Research ◽

Staff Time ◽

Cardiac Device ◽

Time And Motion ◽

Number Of Patients ◽

Time Requirements ◽

Time Required

BACKGROUND The number of patients with cardiac implantable electronic devices (CIEDs) is growing, creating substantial workload for device clinics. OBJECTIVE This study aimed to characterize the workflow and quantify clinic staff time requirements to manage CIED patients. METHODS A time and motion workflow evaluation was performed in 11 US and European CIED clinics. Workflow tasks were repeatedly timed during one business week of observation at each clinic. Observations were inclusive of all device models/manufacturers present. Mean cumulative staff time required to review a Remote device transmission and for an In-person clinic visit were calculated, including all necessary clinical and administrative tasks. Annual staff time for follow-up of 1 CIED patient was modeled using CIED transmission volumes, clinical guidelines, and published literature. RESULTS A total of 276 in-person clinic visits and 2,173 remote monitoring activities were observed. Mean staff time required per remote transmission ranged from 9.4-13.5 minutes for therapeutic devices (pacemaker, ICD, CRT) and 11.3-12.9 mins for diagnostic devices (insertable cardiac monitors (ICMs)). Mean staff time per in-person visit ranged from 37.8-51.0 mins and 39.9-45.8 mins, for therapeutic devices and ICMs respectively. Including all remote and in-person follow-ups, the estimated annual time to manage one CIED patient ranged from 1.6-2.4 hours for therapeutic devices and 7.7-9.3 hours for ICMs. CONCLUSIONS CIED patient management workflow is complex and requires significant staff time. Understanding process steps and time requirements informs implementation of efficiency improvements, including remote solutions. Future research should examine the heterogeneity in patient management processes to identify the most efficient workflows.