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Management of cardiac device-related infections: a review of protocol-driven care

Yasser Rodriguez1, Juan Garisto, Roger G Carrillo

  • 1University of Miami Miller School of Medicine, Miami, FL, United States. Rodriguy@med.umich.edu

International Journal of Cardiology
|October 29, 2011
PubMed

Insights

Cardiac device-related infections (CDIs) are a serious complication. Management should include transesophageal echocardiography, hardware extraction, and targeted antibiotics for methicillin-resistant Staphylococci.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Medical Device Technology

Background:

  • Cardiac device-related infections (CDIs) are increasing with device usage.
  • CDIs are a leading cause for device extraction.
  • Limited data exists on CDI clinical trends, management, and outcomes.

Purpose of the Study:

  • To analyze clinical trends, management strategies, and outcomes of cardiac device-related infections.
  • To identify common pathogens and diagnostic challenges in CDIs.
  • To inform optimal treatment protocols for CDI.

Main Methods:

  • Review of a prospective registry of patients undergoing device extraction from 2004-2009.
  • Inclusion of 506 consecutive patients, with 350 diagnosed with CDI.
  • Analysis of patient demographics, clinical presentation, pathogens, and treatment outcomes.

Main Results:

  • Most patients presented with pocket infection (42%), but cardiac device infective endocarditis (57%) was the most common final diagnosis.
  • Methicillin-resistant Staphylococcus aureus (27%) and epidermidis (23%) were the most common pathogens, causing 69% of deaths.
  • Pocket tissue cultures showed higher concordance with lead-tip cultures (56%) than exudates (31%).

Conclusions:

  • CDIs necessitate specific diagnostic and management protocols.
  • Recommended protocols include transesophageal echocardiography, complete hardware extraction, and broad-spectrum antibiotics targeting methicillin-resistant Staphylococci.
  • Cultures from lead-tips and pocket tissue are crucial; reimplantation decisions require careful consideration based on infection status.
Abstract

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