Introduction Cardiac implantable electronic device (CIED) infections have been shown to be associated with significant morbidity and mortality. Diagnosis can prove clinically challenging particularly in patients with a remote history of CIED implant. The aim of this study was to evaluate the diagnosis and management of patients with CIED infections in a tertiary referral centre.
Methods CIED infections were retrospectively identified from electronic device databases and hospital discharge coding between July 2010 and January 2014. Data was collected from device databases, electronic care records and laboratory records. CIED implantations took place on two sites (Royal Victoria Hospital and Belfast City Hospital) by seven operators and included permanent pacemakers, implantable cardioverter defibrillators and cardiac resynchronisation devices.
Results Forty three cases of CIED infection were identified. Methicillin sensitive staphylococcal was the most common causative organisms cultured whilst a wide range of organisms were cultured. Six cases were culture negative (14%). The CIED was explanted in all 43 cases, the mean time to explantation was 12.6 days with a range of 1–78 days. The average duration of antibiotic therapy was 32 days (range 3–100 days). 15 patients (35%) suffered a complication associated with the CIED infection (Table 1). 27 (62%) patients had a further device implanted. In-hospital mortality was 7% with a six-month mortality of 16%.
Discussion Mortality remains high with CIED associated infections. Complications are common and may be related to the CIED infection or its treatment. The diagnosis can be difficult only 13 (30%) of patients had positive blood cultures and often patients presented with an indolent course. Management of CIED infections are complex and there is a wide variation in time to explantation, antibiotic duration and time to reinplantation. Unifying patient management in line with current guidelines may improve morbidity and mortality and merits further investigation.
- Cardiac implantable electonic device infections
- device explantation
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