[Cardiac implantable electronic device infections; risk factors, prevention and treatment]

The infection rate associated with cardiac implantable electronic devices has increased over the past decades. A recent study found the prevalence of infection after cardiac resynchronization therapy to be more than tenfold higher than reported to the national registry. Risk factors for infection can be host-, procedure-, or device-related, the most important being recent manipulation of the device. Perioperative contamination is the most frequent source, but leads can also be secondarily infected from bacteremia, most commonly with staphylococci. Patients with pocket infection often present with erythema and swelling over the pocket, whereas systemic infection usually produces fever and, in its most severe form, endocarditis. Parenteral empiric antimicrobial therapy should be initiated after drawing blood cultures and followed by transesophageal echocardiogram. Management also includes prompt device extraction, followed by a reevaluation of the indication before reimplantation. Education of operators, related personnel, and referring physicians, prevention of modifiable risk factors, and accurate reporting to national registries are critical actions to limit complications.