Infection of Cardiac Implantable Electronic Devices in Low and Middle Income Countries: A Systematic Review

Area of Science:

• Cardiology
• Infectious Diseases
• Public Health

Background:

• Cardiac implantable electronic devices (CIEDs) are increasingly used in low- and middle-income countries (LMICs).
• CIED-related infections pose significant morbidity, mortality, and healthcare challenges in these regions.
• Limited and fragmented evidence exists regarding CIED infections in LMICs.

Purpose of the Study:

• To systematically review the incidence, microbiological profile, management strategies, and clinical outcomes of CIED-related infections in LMICs.
• To synthesize available data on CIED infection rates and associated risk factors in LMICs.

Main Methods:

• A comprehensive literature search was performed in PubMed and Google Scholar up to September 2025.
• Studies from LMICs reporting on CIED-related infections were included.
• Data on infection rates, device types, reuse, microbiology, management, and outcomes were extracted and synthesized.

Main Results:

• The review included 55 studies with 96,448 CIED recipients, analyzing 1910 infections (overall rate 1.65%).
• Infection risk was higher for complex devices (CRT 5.9%, ICD 4.74%) and reinterventions (2.1%) versus pacemakers (1.75%) and de novo implantations (0.57%).
• Coagulase-negative Staphylococci and Staphylococcus aureus were predominant pathogens, but 35.4% of infections were culture-negative. Device extraction occurred in 75% of cases, with 8.87% infection-related mortality.

Conclusions:

• CIED infections in LMICs occur at higher rates than in high-income countries, particularly with complex devices and reinterventions.
• Culture-negative infections are common, and access to guideline-recommended care, including device extraction, is often limited in LMICs.
• Further research is needed to improve management and outcomes of CIED infections in LMICs.