UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Infections involving cardiac implantable electronic devices

Author
Adolf W Karchmer, MD
Section Editors
Stephen B Calderwood, MD
Leonard I Ganz, MD, FHRS, FACC
Deputy Editor
Elinor L Baron, MD, DTMH

INTRODUCTION

Implanted electronic cardiac devices (CIED; ie, pacemakers and implantable cardioverter-defibrillators [ICDs]) can become infected. The presentation, consequences, and treatment of device infections vary according to the location and extent of infection and the clinical characteristics of the patient [1]. Categories of CIED infections are summarized below. (See 'Clinical manifestations' below.)

The presentation and management of cardiac pacemaker and ICD infections will be discussed here. Noninfectious complications of pacemakers and ICDs are presented separately. (See "Pacing system malfunction: Evaluation and management" and "Unexpected rhythms with normally functioning dual-chamber pacing systems" and "Implantable cardioverter-defibrillators: Complications".)

EPIDEMIOLOGY

Incidence — The true incidence of cardiac device infection is difficult to determine due to the lack of a comprehensive registry or mandatory reporting. A range of values has been reported in a number of observational series [2-6]. In a review of 21 studies of pacemaker and implantable cardioverter-defibrillator (ICD) recipients with variable follow-up, the rate of infections ranged from 0.8 to 5.7 percent [7].

The following observations illustrate the range of findings:

In a series of 8303 pacemaker insertions for which antistaphylococcal periprocedure prophylaxis was routinely administered, pacemaker-associated infection occurred in 468 patients (5.6 percent) [2]. The infection in 44 of these patients (0.5 percent of all insertions) was consistent with a precise definition of pacemaker endocarditis.

                                       

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Mon Dec 05 00:00:00 GMT+00:00 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Baddour LM, Cha YM, Wilson WR. Clinical practice. Infections of cardiovascular implantable electronic devices. N Engl J Med 2012; 367:842.
  2. Arber N, Pras E, Copperman Y, et al. Pacemaker endocarditis. Report of 44 cases and review of the literature. Medicine (Baltimore) 1994; 73:299.
  3. Duval X, Selton-Suty C, Alla F, et al. Endocarditis in patients with a permanent pacemaker: a 1-year epidemiological survey on infective endocarditis due to valvular and/or pacemaker infection. Clin Infect Dis 2004; 39:68.
  4. Uslan DZ, Sohail MR, St Sauver JL, et al. Permanent pacemaker and implantable cardioverter defibrillator infection: a population-based study. Arch Intern Med 2007; 167:669.
  5. Smith PN, Vidaillet HJ, Hayes JJ, et al. Infections with nonthoracotomy implantable cardioverter defibrillators: can these be prevented? Endotak Lead Clinical Investigators. Pacing Clin Electrophysiol 1998; 21:42.
  6. Lai KK, Fontecchio SA. Infections associated with implantable cardioverter defibrillators placed transvenously and via thoracotomies: epidemiology, infection control, and management. Clin Infect Dis 1998; 27:265.
  7. Eggimann P, Waldvogel F. Pacemaker and defibrillator infections. In: Infections Associated with Indwelling Medical Devices, Waldvogel FA, Bisno AL (Eds), American Society for Microbiology Press, Washington, DC 2000. p.247.
  8. Klug D, Balde M, Pavin D, et al. Risk factors related to infections of implanted pacemakers and cardioverter-defibrillators: results of a large prospective study. Circulation 2007; 116:1349.
  9. Johansen JB, Jørgensen OD, Møller M, et al. Infection after pacemaker implantation: infection rates and risk factors associated with infection in a population-based cohort study of 46299 consecutive patients. Eur Heart J 2011; 32:991.
  10. Bloom H, Heeke B, Leon A, et al. Renal insufficiency and the risk of infection from pacemaker or defibrillator surgery. Pacing Clin Electrophysiol 2006; 29:142.
  11. Lekkerkerker JC, van Nieuwkoop C, Trines SA, et al. Risk factors and time delay associated with cardiac device infections: Leiden device registry. Heart 2009; 95:715.
  12. Sohail MR, Henrikson CA, Braid-Forbes MJ, et al. Comparison of mortality in women versus men with infections involving cardiovascular implantable electronic device. Am J Cardiol 2013; 112:1403.
  13. Polyzos KA, Konstantelias AA, Falagas ME. Risk factors for cardiac implantable electronic device infection: a systematic review and meta-analysis. Europace 2015; 17:767.
  14. Sandoe JA, Barlow G, Chambers JB, et al. Guidelines for the diagnosis, prevention and management of implantable cardiac electronic device infection. Report of a joint Working Party project on behalf of the British Society for Antimicrobial Chemotherapy (BSAC, host organization), British Heart Rhythm Society (BHRS), British Cardiovascular Society (BCS), British Heart Valve Society (BHVS) and British Society for Echocardiography (BSE). J Antimicrob Chemother 2015; 70:325.
  15. Da Costa A, Lelièvre H, Kirkorian G, et al. Role of the preaxillary flora in pacemaker infections: a prospective study. Circulation 1998; 97:1791.
  16. Klug D, Lacroix D, Savoye C, et al. Systemic infection related to endocarditis on pacemaker leads: clinical presentation and management. Circulation 1997; 95:2098.
  17. Cacoub P, Leprince P, Nataf P, et al. Pacemaker infective endocarditis. Am J Cardiol 1998; 82:480.
  18. Camus C, Leport C, Raffi F, et al. Sustained bacteremia in 26 patients with a permanent endocardial pacemaker: assessment of wire removal. Clin Infect Dis 1993; 17:46.
  19. Cox JN. Pathology of cardiac pacemakers and central catheters. Curr Top Pathol 1994; 86:199.
  20. Spittell PC, Hayes DL. Venous complications after insertion of a transvenous pacemaker. Mayo Clin Proc 1992; 67:258.
  21. Sohail MR, Uslan DZ, Khan AH, et al. Risk factor analysis of permanent pacemaker infection. Clin Infect Dis 2007; 45:166.
  22. Massoure PL, Reuter S, Lafitte S, et al. Pacemaker endocarditis: clinical features and management of 60 consecutive cases. Pacing Clin Electrophysiol 2007; 30:12.
  23. Sohail MR, Uslan DZ, Khan AH, et al. Management and outcome of permanent pacemaker and implantable cardioverter-defibrillator infections. J Am Coll Cardiol 2007; 49:1851.
  24. Karchmer AW, Longworth DL. Infections of intracardiac devices. Infect Dis Clin North Am 2002; 16:477.
  25. Lewis AB, Hayes DL, Holmes DR Jr, et al. Update on infections involving permanent pacemakers. Characterization and management. J Thorac Cardiovasc Surg 1985; 89:758.
  26. Tarakji KG, Chan EJ, Cantillon DJ, et al. Cardiac implantable electronic device infections: presentation, management, and patient outcomes. Heart Rhythm 2010; 7:1043.
  27. Sohail MR, Uslan DZ, Khan AH, et al. Infective endocarditis complicating permanent pacemaker and implantable cardioverter-defibrillator infection. Mayo Clin Proc 2008; 83:46.
  28. Chamis AL, Peterson GE, Cabell CH, et al. Staphylococcus aureus bacteremia in patients with permanent pacemakers or implantable cardioverter-defibrillators. Circulation 2001; 104:1029.
  29. Uslan DZ, Dowsley TF, Sohail MR, et al. Cardiovascular implantable electronic device infection in patients with Staphylococcus aureus bacteremia. Pacing Clin Electrophysiol 2010; 33:407.
  30. Sohail MR, Palraj BR, Khalid S, et al. Predicting risk of endovascular device infection in patients with Staphylococcus aureus bacteremia (PREDICT-SAB). Circ Arrhythm Electrophysiol 2015; 8:137.
  31. Uslan DZ, Sohail MR, Friedman PA, et al. Frequency of permanent pacemaker or implantable cardioverter-defibrillator infection in patients with gram-negative bacteremia. Clin Infect Dis 2006; 43:731.
  32. Chua JD, Wilkoff BL, Lee I, et al. Diagnosis and management of infections involving implantable electrophysiologic cardiac devices. Ann Intern Med 2000; 133:604.
  33. Schulze MR, Ostermaier R, Franke Y, et al. Images in cardiovascular medicine. Aortic endocarditis caused by inadvertent left ventricular pacemaker lead placement. Circulation 2005; 112:e361.
  34. Voet JG, Vandekerckhove YR, Muyldermans LL, et al. Pacemaker lead infection: report of three cases and review of the literature. Heart 1999; 81:88.
  35. Huang XM, Fu HX, Zhong L, et al. Outcomes of Transvenous Lead Extraction for Cardiovascular Implantable Electronic Device Infections in Patients With Prosthetic Heart Valves. Circ Arrhythm Electrophysiol 2016; 9.
  36. Baddour LM, Epstein AE, Erickson CC, et al. Update on cardiovascular implantable electronic device infections and their management: a scientific statement from the American Heart Association. Circulation 2010; 121:458.
  37. Durack DT, Lukes AS, Bright DK. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. Am J Med 1994; 96:200.
  38. Victor F, De Place C, Camus C, et al. Pacemaker lead infection: echocardiographic features, management, and outcome. Heart 1999; 81:82.
  39. Sarrazin JF, Philippon F, Tessier M, et al. Usefulness of fluorine-18 positron emission tomography/computed tomography for identification of cardiovascular implantable electronic device infections. J Am Coll Cardiol 2012; 59:1616.
  40. Brinker J. Imaging for infected cardiac implantable electronic devices: a new trick for your pet. J Am Coll Cardiol 2012; 59:1626.
  41. Pizzi MN, Roque A, Fernández-Hidalgo N, et al. Improving the Diagnosis of Infective Endocarditis in Prosthetic Valves and Intracardiac Devices With 18F-Fluordeoxyglucose Positron Emission Tomography/Computed Tomography Angiography: Initial Results at an Infective Endocarditis Referral Center. Circulation 2015; 132:1113.
  42. Ahmed FZ, James J, Memmott MJ, Arumugam P. Radionuclide Imaging of Cardiovascular Infection. Cardiol Clin 2016; 34:149.
  43. Baddour LM, Bettmann MA, Bolger AF, et al. Nonvalvular cardiovascular device-related infections. Circulation 2003; 108:2015.
  44. van Hal SJ, Paterson DL, Gosbell IB. Emergence of daptomycin resistance following vancomycin-unresponsive Staphylococcus aureus bacteraemia in a daptomycin-naïve patient--a review of the literature. Eur J Clin Microbiol Infect Dis 2011; 30:603.
  45. Baddour LM, Wilson WR. Infections of prosthetic valves and intravascular devices. In: Principles and Practice of Infectious Diseases, 6th ed, Mandell GL, Bennett JE, Dolin R (Eds), Churchill Livingstone, Philadelphia 2005. p.1022.
  46. Joly V, Belmatoug N, Leperre A, et al. Pacemaker endocarditis due to Candida albicans: case report and review. Clin Infect Dis 1997; 25:1359.
  47. Tascini C, Bongiorni MG, Tagliaferri E, et al. Micafungin for Candida albicans pacemaker-associated endocarditis: a case report and review of the literature. Mycopathologia 2013; 175:129.
  48. Pappas PG, Kauffman CA, Andes DR, et al. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis 2016; 62:e1.
  49. Roger PM, Boissy C, Gari-Toussaint M, et al. Medical treatment of a pacemaker endocarditis due to Candida albicans and to Candida glabrata. J Infect 2000; 41:176.
  50. Aslam S, Hernandez M, Thornby J, et al. Risk factors and outcomes of fungal ventricular-assist device infections. Clin Infect Dis 2010; 50:664.
  51. Cabrera AG, Khan MS, Morales DL, et al. Infectious complications and outcomes in children supported with left ventricular assist devices. J Heart Lung Transplant 2013; 32:518.
  52. Le KY, Sohail MR, Friedman PA, et al. Impact of timing of device removal on mortality in patients with cardiovascular implantable electronic device infections. Heart Rhythm 2011; 8:1678.
  53. Athan E, Chu VH, Tattevin P, et al. Clinical characteristics and outcome of infective endocarditis involving implantable cardiac devices. JAMA 2012; 307:1727.
  54. Mulpuru SK, Pretorius VG, Birgersdotter-Green UM. Device infections: management and indications for lead extraction. Circulation 2013; 128:1031.
  55. Bracke FA, Meijer A, van Gelder LM. Pacemaker lead complications: when is extraction appropriate and what can we learn from published data? Heart 2001; 85:254.
  56. Padfield GJ, Steinberg C, Bennett MT, et al. Preventing cardiac implantable electronic device infections. Heart Rhythm 2015; 12:2344.
  57. Harcombe AA, Newell SA, Ludman PF, et al. Late complications following permanent pacemaker implantation or elective unit replacement. Heart 1998; 80:240.
  58. Byrd CL, Wilkoff BL, Love CJ, et al. Intravascular extraction of problematic or infected permanent pacemaker leads: 1994-1996. U.S. Extraction Database, MED Institute. Pacing Clin Electrophysiol 1999; 22:1348.
  59. Da Costa A, Kirkorian G, Cucherat M, et al. Antibiotic prophylaxis for permanent pacemaker implantation: a meta-analysis. Circulation 1998; 97:1796.
  60. Bertaglia E, Zerbo F, Zardo S, et al. Antibiotic prophylaxis with a single dose of cefazolin during pacemaker implantation: incidence of long-term infective complications. Pacing Clin Electrophysiol 2006; 29:29.
  61. de Oliveira JC, Martinelli M, Nishioka SA, et al. Efficacy of antibiotic prophylaxis before the implantation of pacemakers and cardioverter-defibrillators: results of a large, prospective, randomized, double-blinded, placebo-controlled trial. Circ Arrhythm Electrophysiol 2009; 2:29.
  62. Antimicrobial prophylaxis for surgery. Treat Guidel Med Lett 2012; 10:73.
  63. Wilson W, Taubert KA, Gewitz M, et al. Prevention of Infective Endocarditis. Guidelines From the American Heart Association. A Guideline From the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation 2007; 115 published online April 19, 2007. www.circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA.106.183095v1 (Accessed on May 04, 2007).