Abstract 15979: Utility of Post-extraction Follow-up Blood Cultures in Patients With Cardiovascular Implantable Electronic Device Infection

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
sarwat khalil ◽  
Zerelda Esquer Garrigos ◽  
Douglas W Challener ◽  
Pooja Gurram ◽  
Wajeeha Tariq ◽  
...  
Keyword(s):  
Electronic Device ◽  
Heart Association ◽  
Control Device ◽  
Blood Cultures ◽  
Source Control ◽  
Causative Organism ◽  
Study Cohort ◽  
Device Removal ◽  
Device Infection ◽  
Device Extraction

Introduction: Cardiovascular implantable electronic devices (CIED) infections are frequently complicated with bloodstream infection (BSI). Complete device removal and prolonged antimicrobial therapy is essential for cure. The frequency of persistent BSI after source control (device extraction) is not well described. This study aims to assess the utility of repeat blood cultures (BC) after device extraction as recommended by the American Heart Association (AHA) guidelines. Methods: We selected patients who presented with BSI in the setting of CIED infection and underwent device removal at Mayo Clinic Rochester between 2012 and 2017. Cases where BC were not drawn prior to extraction, or repeated within 72 hours of device extraction, or met criteria for contamination were excluded. Results: Of 656 patients who underwent CIED extraction for device infection, 190 with post-extraction BC met study criteria. Among the final study cohort (Table 1), 159 patients had negative BC, while 31 had positive BC following CIED extraction. Pre-extraction, the most common causative organism was Staphylococcus aureus (91/190, 48%) (Figure 1a). Post-extraction, 22 of the 31 (71%) cases of persistent BSI were due to S. aureus (Fig 1b). The median duration of BSI was not significantly different between negative and positive BC groups (3 versus 4 days, p=0.92). Conclusions: Majority of patients had resolution of BSI after CIED extraction. S. aureus was the most common cause of persistent BSI post-extraction. Our findings support the AHA guidelines of repeating BC after device extraction, especially for S aureus .

scholarly journals 1178. Cardiac Device Infection: Do We Follow the Guidelines?

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S422-S422
Author(s):  
Sandhya Nagarakanti ◽  
Eliahu Bishburg ◽  
Anita Bapat
Keyword(s):  
Electronic Device ◽  
Tertiary Care ◽  
Extraction Procedure ◽  
Heart Association ◽  
Care Hospital ◽  
Cardiac Device ◽  
Device Infection ◽  
Microbiological Criteria ◽  
Pocket Infection ◽  
Work Up

Abstract Background Cardiovascular implantable electronic device (CIED) such as pacemaker (PPM) and automated implantable cardiac defibrillator (AICD) are commonly utilized in clinical practice. Definitions of device infection (DI) and guidelines for the work up and device extraction (DE) have been published by the American Heart Association and the Infectious Disease Society of America. Our objective was to evaluate whether the work up of DI as recommended was followed, and whether the device was extracted according to guidelines. Methods A retrospective review in a 680-bed tertiary care hospital. Adult patients (patients) >18 years. who were diagnosed as having a DI and had the device extracted between 2008 and 2017 were included. Data were collected on demographics, device duration, blood culture (BC), echocardiogram utilization, lead cultures (LC) and device pocket cultures, appropriateness of extraction as per guidelines. Results Ninety-five patients were included. Mean age 68 years (range 23–90). 67 (70%) were male. Devices included: AICD in 75 (79%), PPM in 20(21%). CIED was present <1 year prior to infection in 24(24%). Compliance with guidelines recommendation to draw blood cultures, obtain an echocardiogram and send lead cultures and device pocket cultures were seen in 100%, 90.5% and 49.4% and 67.7%, respectively. Criteria for extraction was met in 65/95 (69%); reason for extraction was a pocket infection in 16/65(24.6%), bacteremia in 49/65 (75%), infective endocarditis in 38/65(58%). Thirty (31.5%) had device extracted without meeting guidelines recommendation, in 17 a diagnosis of pocket infection but without microbiological criteria or clinical diagnosis. In 9 patients lead vegetations were seen but no cultures to support extraction. Mortality was seen in 4 patients, one during the extraction procedure. Conclusion In our institution, 1/3 of the patients diagnosed with DI had no indication for DE. Guidelines recommendation for CIED extraction should be followed as extraction could be associated with significant complications. In this study, overall compliance with guidelines work up recommendations were not consistently followed, especially LC and device pocket cultures. Disclosures All authors: No reported disclosures.

scholarly journals 57. Evaluation of the 2019 European Heart Rhythm Association International Consensus Document in Patients with Cardiovascular Implantable Electronic Devices Who Develop Staphylococcus aureus Bacteremia

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S40-S40
Author(s):  
Supavit Chesdachai ◽  
Larry M Baddour ◽  
Muhammad R Sohail ◽  
Raj Palraj ◽  
Malini Madhavan ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Electronic Device ◽  
Heart Rhythm ◽  
Consensus Document ◽  
Staphylococcus Aureus Bacteremia ◽  
Device Infection ◽  
Significant Difference ◽  
Device Extraction ◽  
One Year ◽  
The Impact

Abstract Background Cardiovascular implantable electronic device (CIED) implantation has markedly increased over the past two decades. Staphylococcus aureus bacteremia (SAB) occurs in patients with CIED and determination of device infection among patients without clinical findings of pocket site infection is often difficult. Our study examines the characteristics, management, and outcomes of SAB in patients living with CIED using 2019 international criteria to define CIED infection. Methods We conducted a retrospective study of patients with CIED who were hospitalized at Mayo Clinic, Rochester, with SAB from January 1, 2012 to December 31, 2019. Patients who met CIED infection criteria following SAB based on the 2019 European Heart Rhythm Association International Concensus Document were identified. A time-to-event analysis was used to determine the impact, if any, of complete device extraction on outcomes. Results Overall, 110 patients with CIED developed SAB and 92 (83.6%) of them underwent transesophageal echocardiogram (TEE). Eighty-eight (80%) had CIED infection with 57 (51.8%) and 31 (28.2%) patients meeeting criteria for definite and possible CIED infections, respectively. Forty-three (75.4%) patients with definite CIED infection underwent complete device extraction. For possible and rejected CIED infection, the rates of complete device extraction were 35.5% and 27.3%, respectively (p&lt; .001 for each). The primary endpoint of a composite of one-year mortality and SAB relapse had a rate that was significantly lower in patients with CIED infection who underwent complete device extraction as compared to that of patients who did not undergo device extraction (25.9% vs. 76.5%, p&lt; .001). No significant difference in outcomes was seen in the rejected CIED infection group (33.3% vs. 62.5%, p =.27). Conclusion The rate of CIED infections following SAB was higher than that reported previously. Increased use of TEE and a novel case definition with broader diagnostic criteria were likely operative, in part, in accounting for the the higher rate of CIED infections complicating SAB. Complete device removal is critical in patients with either definite or possible CIED infection as defined by the 2019 consensus document to improve one-year mortality and SAB relapse rates. Disclosures Larry M. Baddour, MD, Boston Scientific (Individual(s) Involved: Self): Consultant; Botanix Pharmaceuticals (Individual(s) Involved: Self): Consultant; Roivant Sciences (Individual(s) Involved: Self): Consultant Muhammad R. Sohail, MD, Medtronic (Consultant)Philips (Consultant)

Abstract 20081: Predicting Risk of Endovascular Device Infection in Patients with Staphylococcus aureus Bacteremia

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Muhammad Sohail ◽  
Bharath Raj Palraj ◽  
Sana Khalid ◽  
Daniel Uslan ◽  
Farah Al-Saffar ◽  
...  
Keyword(s):  
Electronic Device ◽  
Clinical Signs ◽  
Infection Model ◽  
Multivariable Model ◽  
Operating Characteristics ◽  
Clinical Predictors ◽  
Staphylococcus Aureus Bacteremia ◽  
Increased Risk ◽  
Device Infection ◽  
Device Extraction

Objectives: Clinicians need to identify which patients presenting with S. aureus bacteremia (SAB) have underlying cardiovascular implantable electronic device (CIED) infection and therefore need device extraction. The goal of this study was to identify clinical predictors of CIED infection in patients presenting with SAB. Methods: We retrospectively reviewed all cases of SAB in CIED recipients at Mayo Clinic from Jan 2001 to Dec 2011. CIED infection was defined using clinical, microbiologic and echocardiographic criteria. Patients who presented with clinical signs of CIED pocket infection were excluded. A multivariable model was developed to identify independent predictors of CIED infection. Model discrimination was summarized using the area under a receiver operating characteristics curve (AUC). Results: Among the 131 patients with SAB and CIED, 45 (34%) had underlying CIED infection. Permanent pacemaker (PPM) devices (OR 3.90, 95% CI 1.65-9.23, p=0.002), >1 device-related procedure (OR 3.30, 95% CI 1.23-8.86, p=0.018), and duration of SAB ≥4 days (OR 5.54, 95% CI 3.32-13.23, p <0.001) were independently associated with an increased risk of CIED infection. The AUC for this multivariable model was 0.79 indicating good discriminatory capacity to separate SAB patients with and without CIED infection. Various combinations of these three features and the corresponding predicted probabilities of CIED infection are summarized in Table. Conclusions: An individual patient’s risk of underlying CIED infection can be calculated based on the type of device, number of device-related procedures, and duration of SAB. Patients without any of these high-risk features have very low risk of underlying CIED infection and may be monitored closely without immediate device extraction.

scholarly journals Approach to Diagnosis of Cardiovascular Implantable-Electronic-Device Infection

2018 ◽  
Vol 56 (7) ◽  
Author(s):  
Daniel C. DeSimone ◽  
M. Rizwan Sohail
Keyword(s):  
Susceptibility Testing ◽  
Electronic Device ◽  
Emission Tomography ◽  
Evidence Based ◽  
Device Removal ◽  
Advanced Imaging ◽  
Significant Challenge ◽  
Positron Emission ◽  
Device Infection ◽  
Cardiovascular Implantable Electronic Device

ABSTRACT Device infection remains a significant challenge as clinical indications for cardiovascular implantable electronic device (CIED) therapy continue to expand beyond the prevention and treatment of cardiac arrhythmias. Patients receiving CIED therapy are now older and have significant comorbidities, placing them at higher risk of complications, including infection. CIED infection warrants complete device removal, as retention is associated with an unacceptably high risk of relapse and increased mortality. However, accurate diagnosis of CIED infections remains a significant challenge that is based on a combination of findings on physical examination, microbiological and laboratory testing, and advanced imaging, such as transesophageal echocardiography or positron emission tomography. Isolating a causative pathogen and performing susceptibility testing are crucial for appropriate choice, route, and duration of antimicrobial therapy. In this review, we present an evidence-based approach to diagnosis of CIED infection.

scholarly journals Postimplantation pocket hematoma increases risk of cardiac implantable electronic device infection: A meta‐analysis

2021 ◽  
Author(s):  
Jakrin Kewcharoen ◽  
Chanavuth Kanitsoraphan ◽  
Sittinun Thangjui ◽  
Thiratest Leesutipornchai ◽  
Sakditad Saowapa ◽  
...  
Keyword(s):  
Electronic Device ◽  
Meta Analysis ◽  
Cardiac Implantable Electronic Device ◽  
Device Infection ◽  
Pocket Hematoma

scholarly journals Brucella cardiac implantable electronic device infection: A single-center case series

2021 ◽  
pp. 102568
Author(s):  
Fatehi Elzein ◽  
Eid Alsufyani ◽  
Yahya Al Hebaishi ◽  
Mohammed Mosaad ◽  
Moayad Alqurashi ◽  
...  
Keyword(s):  
Electronic Device ◽  
Case Series ◽  
Single Center ◽  
Cardiac Implantable Electronic Device ◽  
Device Infection

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

Hearts ◽  
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 ◽  
Cardiac Implantable Electronic Devices ◽  
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.

scholarly journals Open Source Control Device for Industry 4.0 Based on RAMI 4.0

Electronics ◽  
2021 ◽  
Vol 10 (7) ◽  
pp. 869
Author(s):  
Pablo F. S. Melo ◽  
Eduardo P. Godoy ◽  
Paolo Ferrari ◽  
Emiliano Sisinni
Keyword(s):  
Open Source ◽  
Industry 4.0 ◽  
Product Life Cycle ◽  
Manufacturing Systems ◽  
Industrial Revolution ◽  
Control Device ◽  
Source Control ◽  
Reference Architecture ◽  
Architecture Model ◽  
Complex Relationships

The technical innovation of the fourth industrial revolution (Industry 4.0—I4.0) is based on the following respective conditions: horizontal and vertical integration of manufacturing systems, decentralization of computing resources and continuous digital engineering throughout the product life cycle. The reference architecture model for Industry 4.0 (RAMI 4.0) is a common model for systematizing, structuring and mapping the complex relationships and functionalities required in I4.0 applications. Despite its adoption in I4.0 projects, RAMI 4.0 is an abstract model, not an implementation guide, which hinders its current adoption and full deployment. As a result, many papers have recently studied the interactions required among the elements distributed along the three axes of RAMI 4.0 to develop a solution compatible with the model. This paper investigates RAMI 4.0 and describes our proposal for the development of an open-source control device for I4.0 applications. The control device is one of the elements in the hierarchy-level axis of RAMI 4.0. Its main contribution is the integration of open-source solutions of hardware, software, communication and programming, covering the relationships among three layers of RAMI 4.0 (assets, integration and communication). The implementation of a proof of concept of the control device is discussed. Experiments in an I4.0 scenario were used to validate the operation of the control device and demonstrated its effectiveness and robustness without interruption, failure or communication problems during the experiments.

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