Cardiac implantable electronic device infection: Does the device need to be extracted?

Area of Science:

• Cardiology
• Infectious Diseases
• Medical Device Technology

Background:

• Cardiac implantable electronic devices (CIEDs) are increasingly used, leading to a rise in device infections.
• Published guidelines exist for diagnosing CIED infections (CDI), recommending specific work-ups and extraction criteria.
• Adherence to these guidelines in clinical practice remains largely unquantified.

Purpose of the Study:

• To evaluate adherence to CIED infection guidelines in a hospital setting.
• To assess if diagnosed CIEDs met guideline criteria for extraction.
• To determine if recommended work-up procedures for CDI were consistently followed.

Main Methods:

• Retrospective review of adult patients (≥18 years) with CIED extraction and a CDI diagnosis.
• Data collected from 2008 to 2017.
• Analysis of 95 identified patient cases.

Main Results:

• Work-up for CDI was inconsistently performed: blood cultures (100%), echocardiograms (90.5%), lead cultures (75.6%), and pocket cultures (49.3%).
• A significant proportion (33%) of patients undergoing device extraction did not meet guideline criteria for CDI.
• Low adherence was observed in obtaining lead and pocket cultures.

Conclusions:

• One-third of CIED extractions for suspected infection lacked guideline justification.
• Inconsistent adherence to recommended CDI work-up and extraction protocols was noted.
• Strict adherence to CIED extraction guidelines is crucial to minimize unnecessary procedures, complications, and costs.