Implantable cardiac device infections prevalence: diagnostic and therapeutic implications

Abstract

BACKGROUND: Cardiac implanted electronic device (CIED)-related infection is a serious complication characterized by a high rate of mortality and morbidity. AIM: The objectives of the study were 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 using the medical records of 1871 individuals who had initial CIED implant or replacement during the period from January 2007 to December 2017. RESULTS: Fifty-nine infectious episodes were identified. 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 rate of pocket infection (PI) and CIED-related endocarditis (CDE) was 1.54% and 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 1 lead. Gram-positive cocci were the most isolated organisms in all positive cultures (69.23%). 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 PI individuals (20.83% vs. 2.86%; p = 0.025). CONCLUSION: In our center, the rate of CIED implantation is increasing, the incidence of CIED-related infection is declining. Until now, the infection burden associated with secondary intervention is still significantly high. The optimum management strategy is to eliminate the entire system for patients presented with infection, especially those with CDE. However, the mortality rate is still high.