Infections of cardiac implantable electronic devices: Epidemiology, classification, treatment, and prognosis

Adv Clin Exp Med. 2019 Feb;28(2):263-270. doi: 10.17219/acem/80665.

Abstract

The increasing number of implantation procedures of implantable cardiac electronic devices (ICEDs) leads to a substantial growth of a cohort of patients in whom complications of such a therapy occur. Infective complications are among the most severe ones, as they are often associated with poor prognosis. Depending on the criteria applied, the incidence of cardiac device infection (CDI) is estimated at 0.5-2.2%. Many risk factors of CDIs have been identified, among which the most important are numerous previous cardiac electrotherapy procedures and their complexity, and the lack of perioperative antibiotic prophylaxis. Appropriate diagnosis of a suspected CDI is of utmost importance, as well as the correct classification of the infection, which leads to adequate treatment. Management of a CDI should include complete removal of the implanted device. Additionally, empirical and then targeted antibiotic therapy should be instituted. The prognosis of CDI may, nonetheless, be unfavorable. Despite appropriate treatment, the total mortality rate of such complication is estimated to be as high as 35%.

Keywords: cardiac pacemaker; implantable cardiac electronic device; implantable cardioverter-defibrillator; infective complications; infective endocarditis.

Publication types

  • Review

MeSH terms

  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / therapeutic use
  • Antibiotic Prophylaxis / methods*
  • Bacterial Infections / epidemiology*
  • Bacterial Infections / etiology
  • Defibrillators, Implantable / adverse effects*
  • Defibrillators, Implantable / statistics & numerical data
  • Device Removal
  • Humans
  • Pacemaker, Artificial*
  • Prognosis
  • Prosthesis-Related Infections / diagnosis
  • Prosthesis-Related Infections / drug therapy
  • Prosthesis-Related Infections / epidemiology
  • Prosthesis-Related Infections / microbiology*
  • Risk Factors

Substances

  • Anti-Bacterial Agents