Download PDF
Semin Plast Surg 2016; 30(02): 060-065
DOI: 10.1055/s-0036-1580733
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Treatment of Infected Cardiac Implantable Electronic Devices

Abdulla Fakhro
1   Division of Plastic and Reconstructive Surgery, Baylor College of Medicine, Houston, Texas
,
Faryan Jalalabadi
1   Division of Plastic and Reconstructive Surgery, Baylor College of Medicine, Houston, Texas
,
Rodger H. Brown
1   Division of Plastic and Reconstructive Surgery, Baylor College of Medicine, Houston, Texas
,
Shayan A. Izaddoost
1   Division of Plastic and Reconstructive Surgery, Baylor College of Medicine, Houston, Texas
› Author Affiliations
Further Information

Publication History

Publication Date:
04 May 2016 (online)

   Permissions and Reprints

Abstract

With their rising benefits, cardiac implantable electronic devices (CIEDs) such as pacemakers and left ventricular assist devices (LVADs) have witnessed a sharp rise in use over the past 50 years. As indications for use broaden, so too does their widespread employment with its attendant rise of CIED infections. Such large numbers of infections have inspired various algorithms mandating treatment. Early diagnosis of inciting organisms is crucial to tailoring appropriate antibiotic and or antifungal treatment. In addition, surgical debridement and explant of the device have been a longstanding modality of care. More novel therapies focus on salvage of the device by way of serial washouts and instilling drug-eluting antibiotic impregnated beads into the wound. The wound is then serially debrided until clean and closed. This technique is better suited to patients whose device cannot be removed, patients who are poor candidates for cardiac surgery, or patients who have failed conventional prior treatments.

Keywords

cardiac implantable electronic devices - left ventricular devices - infection - salvage therapy - antibiotic beads
 

  • References

  • 1 Myerburg RJ. Implantable cardioverter-defibrillators after myocardial infarction. N Engl J Med 2008; 359 (21) 2245-2253
    CrossrefPubMedGoogle Scholar
  • 2 Antman EM. Cardiovascular Therapeutics: A Companion to Braunwald's Heart Disease. 2nd ed. Philadelphia: WB Saunders; 2002
    Google Scholar
  • 3 Goldberger Z, Lampert R. Implantable cardioverter-defibrillators: expanding indications and technologies. JAMA 2006; 295 (7) 809-818
    CrossrefPubMedGoogle Scholar
  • 4 Voigt A, Shalaby A, Saba S. Continued rise in rates of cardiovascular implantable electronic device infections in the United States: temporal trends and causative insights. Pacing Clin Electrophysiol 2010; 33 (4) 414-419
    CrossrefPubMedGoogle Scholar
  • 5 Kretlow JD, Brown RH, Wolfswinkel EM , et al. Salvage of infected left ventricular assist device with antibiotic beads. Plast Reconstr Surg 2014; 133 (1) 28e-38e
    CrossrefPubMedGoogle Scholar
  • 6 Sohail MR, Henrikson CA, Braid-Forbes MJ, Forbes KF, Lerner DJ. Mortality and cost associated with cardiovascular implantable electronic device infections. Arch Intern Med 2011; 171 (20) 1821-1828
    CrossrefPubMedGoogle Scholar
  • 7 Eggimann P, Waldvogel FA. Infections Associated with Indwelling Medical Devices: Pacemaker and Defibrillator Infections. 3rd ed. Washington, DC: ASM Press; 2000
    Google Scholar
  • 8 Topkara VK, Kondareddy S, Malik F , et al. Infectious complications in patients with left ventricular assist device: etiology and outcomes in the continuous-flow era. Ann Thorac Surg 2010; 90 (4) 1270-1277
    CrossrefPubMedGoogle Scholar
  • 9 Sastry S, Rahman R, Yassin MH. Cardiac implantable electronic device infection: from an infection prevention perspective. Adv Prev Med 2015; 2015: 357087
    PubMedGoogle Scholar
  • 10 Baddour LM, Bettmann MA, Bolger AF , et al; AHA. Nonvalvular cardiovascular device-related infections. Circulation 2003; 108 (16) 2015-2031
    CrossrefPubMedGoogle Scholar
  • 11 Baddour LM, Cha YM, Wilson WR. Clinical practice. Infections of cardiovascular implantable electronic devices. N Engl J Med 2012; 367 (9) 842-849
    CrossrefPubMedGoogle Scholar
  • 12 Baddour LM, Epstein AE, Erickson CC , et al; American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee; Council on Cardiovascular Disease in Young; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Nursing; Council on Clinical Cardiology; Interdisciplinary Council on Quality of Care; American Heart Association. Update on cardiovascular implantable electronic device infections and their management: a scientific statement from the American Heart Association. Circulation 2010; 121 (3) 458-477
    CrossrefPubMedGoogle Scholar
  • 13 Dy Chua J, Abdul-Karim A, Mawhorter S , et al. The role of swab and tissue culture in the diagnosis of implantable cardiac device infection. Pacing Clin Electrophysiol 2005; 28 (12) 1276-1281
    CrossrefPubMedGoogle Scholar
  • 14 Sohail MR, Uslan DZ, Khan AH , et al. Management and outcome of permanent pacemaker and implantable cardioverter-defibrillator infections. J Am Coll Cardiol 2007; 49 (18) 1851-1859
    CrossrefPubMedGoogle Scholar
  • 15 Rodriguez Y, Garisto J, Carrillo RG. Management of cardiac device-related infections: a review of protocol-driven care. Int J Cardiol 2013; 166 (1) 55-60
    CrossrefPubMedGoogle Scholar
  • 16 Tarakji KG, Chan EJ, Cantillon DJ , et al. Cardiac implantable electronic device infections: presentation, management, and patient outcomes. Heart Rhythm 2010; 7 (8) 1043-1047
    CrossrefPubMedGoogle Scholar
  • 17 Nagpal A, Baddour LM, Sohail MR. Microbiology and pathogenesis of cardiovascular implantable electronic device infections. Circ Arrhythm Electrophysiol 2012; 5 (2) 433-441
    CrossrefPubMedGoogle Scholar
  • 18 Passerini de Rossi B, Feldman L, Pineda MS, Vay C, Franco M. Comparative in vitro efficacies of ethanol-, EDTA- and levofloxacin-based catheter lock solutions on eradication of Stenotrophomonas maltophilia biofilms. J Med Microbiol 2012; 61 (Pt 9) 1248-1253
    CrossrefPubMedGoogle Scholar
  • 19 Meyer C, Bierbaum G, Heidrich C , et al. Nucleotide sequence of the lantibiotic Pep5 biosynthetic gene cluster and functional analysis of PepP and PepC. Evidence for a role of PepC in thioether formation. Eur J Biochem 1995; 232 (2) 478-489
    CrossrefPubMedGoogle Scholar
  • 20 Monkowski DH, Axelrod P, Fekete T, Hollander T, Furukawa S, Samuel R. Infections associated with ventricular assist devices: epidemiology and effect on prognosis after transplantation. Transpl Infect Dis 2007; 9 (2) 114-120
    CrossrefPubMedGoogle Scholar
  • 21 Toda K, Yonemoto Y, Fujita T , et al. Risk analysis of bloodstream infection during long-term left ventricular assist device support. Ann Thorac Surg 2012; 94 (5) 1387-1393
    CrossrefPubMedGoogle Scholar
  • 22 Benaerts PJ, Ridler BM, Vercaeren P, Thompson JF, Campbell WB. Gentamicin beads in vascular surgery: long-term results of implantation. Cardiovasc Surg 1999; 7 (4) 447-450
    CrossrefPubMedGoogle Scholar
  • 23 Deharo JC, Quatre A, Mancini J , et al. Long-term outcomes following infection of cardiac implantable electronic devices: a prospective matched cohort study. Heart 2012; 98 (9) 724-731
    CrossrefPubMedGoogle Scholar
  • 24 Franceschi F, Thuny F, Giorgi R , et al. Incidence, risk factors, and outcome of traumatic tricuspid regurgitation after percutaneous ventricular lead removal. J Am Coll Cardiol 2009; 53 (23) 2168-2174
    CrossrefPubMedGoogle Scholar
  • 25 Nishimura RA, Carabello BA, Faxon DP , et al; American College of Cardiology/American Heart Association Task Force. ACC/AHA 2008 guideline update on valvular heart disease: focused update on infective endocarditis: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 2008; 118 (8) 887-896
    CrossrefPubMedGoogle Scholar
  • 26 Wazni O, Epstein LM, Carrillo RG , et al. Lead extraction in the contemporary setting: the LExICon study: an observational retrospective study of consecutive laser lead extractions. J Am Coll Cardiol 2010; 55 (6) 579-586
    CrossrefPubMedGoogle Scholar
  • 27 Stone PA, Mousa AY, Hass SM , et al. Antibiotic-loaded polymethylmethacrylate beads for the treatment of extracavitary vascular surgical site infections. J Vasc Surg 2012; 55 (6) 1706-1711
    CrossrefPubMedGoogle Scholar
  • 28 Scott DM, Rotschafer JC, Behrens F. Use of vancomycin and tobramycin polymethylmethacrylate impregnated beads in the management of chronic osteomyelitis. Drug Intell Clin Pharm 1988; 22 (6) 480-483
    PubMedGoogle Scholar
  • 29 Stone PA, Back MR, Armstrong PA , et al. Evolving microbiology and treatment of extracavitary prosthetic graft infections. Vasc Endovascular Surg 2008; 42 (6) 537-544
    PubMedGoogle Scholar
  • 30 Tintle SM, Forsberg JA, Potter BK, Islinger RB, Andersen RC. Prosthesis retention, serial debridement, and antibiotic bead use for the treatment of infection following total joint arthroplasty. Orthopedics 2009; 32 (2) 87
    PubMedGoogle Scholar
  • 31 Shi M, Kretlow JD, Nguyen A , et al. Antibiotic-releasing porous polymethylmethacrylate constructs for osseous space maintenance and infection control. Biomaterials 2010; 31 (14) 4146-4156
    CrossrefPubMedGoogle Scholar