scholarly journals Implantable Cardiac Device Infections Prevalence: Diagnostic and Therapeutic Implications

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.

Cardiac device therapy

2018 ◽  
Author(s):  
Kim Rajappan
Keyword(s):  
Cardiac Resynchronization ◽  
Steady Increase ◽  
Implantable Cardioverter Defibrillators ◽  
Device Therapy ◽  
Cardiac Device ◽  
Cardiac Devices ◽  
Cardiac Resynchronization Therapy Devices ◽  
Number Of Patients ◽  
Different Types ◽  
Cardioverter Defibrillators

The term ‘device therapy’ is used in cardiology to refer to three different types of implantable cardiac-rhythm-management devices: pacemakers, implantable cardioverter defibrillators (also known as ICDs), and cardiac resynchronization therapy devices (also known as CRT devices). There has been a steady increase in the number of patients receiving these cardiac devices; in relation to CRT devices, the increase has been almost exponential.

Abstract 375: Surgical Site Infection after Initial and Replacement Cardiac Implantable Electronic Devices: Leveraging the Electronic Medical Record to Develop a Surveillance Model

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Faith Anthony ◽  
Kim T Phan ◽  
Mary-Lou Kiley
Keyword(s):  
Surgical Site Infection ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Electronic Device ◽  
Cardiac Resynchronization ◽  
Site Infection ◽  
Infection Rates ◽  
Cardiac Device ◽  
Screening Algorithm ◽  
Cardiac Resynchronization Therapy Devices

Objective: While surgical site infection (SSI) rates tend to be low in patients with a Cardiac Implantable Electronic Device (CIED), the occurrence of infection can be devastating to the patient and costly to manage. Accurate surveillance and reporting of infections can assist in future risk stratification and mitigation in this population. Our purpose is (1) to describe the incidence of SSI after CIED implantation using a cardiac device registry in a large HMO and (2) to illustrate the process of infection validation utilizing a screening algorithm in the Electronic Medical Record (EMR) of registered patients. Methods and Results: A longitudinal cohort study was performed to identify patients with a CIED implanted between 1/1/2007 and 12/31/2013. A screening algorithm (Figure 1) for detection of SSI includes (1) triggers for review in the registry, (2) International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for screening in the EMR, and (3) validation of flagged cases in the EMR. There were 11,924 Implantable Cardioverter Debrillators (7929 initial and 3995 replacement); 33,519 Pacemakers(23,772 initial and 9747 replacement); and 4472 cardiac resynchronization therapy devices (2537 initial and 1935 replacement) registered during the study period in 47,312 patients. Deep infection rates are shown in Figure 2 below. Superficial and Organ Space Infection rates remained low for all device types for combined rates of ≤0.03 and ≤0.10 respectively. Conclusion: In a population where the incidence of infection is often less than 1%, a comprehensive, sensitive, and specific model for infection screening and validation is necessary to accurately identify and classify surgical site infections.

scholarly journals Evaluation of P- POSSUM Scoring System in Patients Undergoing Emergency Laparotomy

2017 ◽  
Vol 16 (2) ◽  
pp. 28-36
Author(s):  
Manoj Kumar Jha ◽  
Yahun Chandra Sibakoti ◽  
Harihar Devkota
Keyword(s):  
Risk Factors ◽  
Mortality Rate ◽  
Prospective Study ◽  
Scoring System ◽  
Emergency Laparotomy ◽  
Mortality And Morbidity ◽  
Operative Severity Score ◽  
Significant Difference ◽  
One Year ◽  
Operative Findings

Introduction: The Physiological and Operative Severity Score for the enumeration of Mortality and morbidity (POSSUM) and its modification the Portsmouth POSSUM (P-POSSUM), have been proposed as a method for standardizing patient data so that direct comparisons can be made despite differing patterns of referral and population. In this prospective study, the validity of P-POSSUM was tested in patients undergoing emergency laparotomy and the risk factors for low outcome were noted.Methods: This is the Prospective Study and was conducted in Department of surgery, of a tertiary level hospital. The study period was from April 2014- April 2015 for one year. Patients admitted under department of general surgery scheduled to undergo emergency laparotomy were included and scored according to their physiological and operative findings using a proforma sheet. Physiological scoring was performed just before surgery and operative scoring was carried out intra-operatively. Patients were followed-up for the first 30 days postoperative period. The observed mortality rate was compared with the P-POSSUM predicted mortality rate. Data analysis was done using SPSS 20.Results: A total of 60 patients who met the inclusion criteria were included in this study. On applying linear analysis, an observed to expected ratio of 1.18 was obtained, indicating a significant fit for predicting the post-operative adverse outcome. There was no significant difference between the observed and predicted mortality rates (x2 = 1.467, 4 df., P = 0.833). It was found to be comparable to other studies. In all the risk factors studied, a positive correlation was found between deaths and higher POSSUM scores.Conclusion: Portsmouth POSSUM scoring system serves as a good predictor of post-operative outcome in emergency laparotomy procedures.

scholarly journals Prevalence and risk factors related to infections of cardiac resynchronization therapy devices

2009 ◽  
Vol 31 (2) ◽  
pp. 203-210 ◽  
Author(s):  
C. Romeyer-Bouchard ◽  
A. Da Costa ◽  
V. Dauphinot ◽  
M. Messier ◽  
L. Bisch ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Resynchronization Therapy ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Cardiac Resynchronization Therapy Devices

scholarly journals IMPLANTABLE CARDIAC DEVICE INFECTION - A CLINICAL AUDIT

2021 ◽  
Vol 70 (Suppl-4) ◽  
pp. S871-75
Author(s):  
Muhammad Asad ◽  
Qurban Hussain Khan ◽  
Mir Waqas Baloch ◽  
Kumail Abbas Khan ◽  
Muhammad Amer Naseem ◽  
...  
Keyword(s):  
Risk Factors ◽  
Infection Rate ◽  
Clinical Laboratory ◽  
Electronic Devices ◽  
Laboratory Data ◽  
Site Infection ◽  
Cardiac Device ◽  
Cardiac Implantable Electronic Devices ◽  
Cardiac Devices ◽  
Device Infection

Objective: Cardiac Implantable Electronic Devices are being implanted more commonly now compared to the past. Due to the rise in implantation rate complication have also considered to increase. One of the dreadful complications is devices infection. This study was conducted to assess retrospectively the rate of device infection and risk factors associated with it. Study Design: Observational study. Place and Duration of Study: AFIC/NIHD, Rawalpindi, from Jan 2018 to Jan 2019. Methodology: A total of 356 patients who underwent cardiac devices implantation. Their records were studied and all the patients who developed device infections were further reviewed in detail. Demographic details, clinical, laboratory data and imaging records were evaluated. Patients were classified into different categories of infections based on predefined criteria according to the guidelines. Risk factors were also taken into account. Results: Out of 356 devices 14 got infected and infection rate was 3.9%. Generator site infection was seen in 6 followed by generator erosion in 5 while 2 had pocket site infection with bacteremia and 1 developed pocket site infection with lead/valvular endocarditis. Dual chamber permanent pacemakers were infected the most. Denovo devices had high infection rate compared to replacement. Microbes were identified in 3 patients. Conclusions: Our findings suggest that the increasing incidence of Cardiac Implantable electronic devices infection in current clinical settings was multifactorial. Care should be taken at every step starting from preoperative, intraoperative to postoperative stage for prevention of device infection.

Staphylococcus aureus nasal colonization among Vietnamese adults: prevalence, risk factors and antibiotic susceptibility profile

MedPharmRes ◽  
2018 ◽  
Vol 2 (2) ◽  
pp. 21-31
Author(s):  
Nguyen Phan ◽  
Hien Pham ◽  
Thuc Nguyen ◽  
Hoai Nguyen
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Antibiotic Susceptibility ◽  
Nasal Carriage ◽  
Resistance Rate ◽  
High Rate ◽  
Weight History ◽  
Potential Risk Factors ◽  
History Of ◽  
Vietnamese Community

Staphylococcus aureus (S. aureus) has long been recognized as an important human pathogen causing many severe diseases. It is also a part of human normal flora with its ecological niche in the human anterior nares. This study focused on screening S. aureus nasal carriage in community and its relationship to human physiological and pathological factors which have not been studied in Vietnam previously. Two hundred and five volunteers in Ho Chi Minh City from 18 to 35 and over 59 years old both male and female participated in the study. Result showed that the prevalence of S. aureus nasal carriage in southern Vietnamese community was relatively low, only 11.2% (23/205), much lower than that in other international reports on human S. aureus. In addition, nasal carriage of the older age group (> 59 years old, 13.7%) was higher than that of younger age (18-35 years old, 10.4%). Other potential risk factors such as gender, career, height, weight, history of antibiotic usage, daily nasal wash, use of nasal medication sprays, acne problems, smoking and nasal problems showed no significant impact on S. aureus carriage. The obtained S. aureus nasal isolates were all sensitive to vancomycin. Lincomycin and tetracycline had low resistance rate with 4.3 % and 17.4 %, respectively. However, the isolates showed particularly high rate of multidrug resistance (54.2%) In summary, our data provided researchers an overview on S. aureus nasal carriage and antibiotic susceptibility profile of the community- isolated S. aureus in Vietnam. This would serve as valuable information on assessing risk of community-acquired S. aureus infections.

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