title: Management of cardiac device infections: A retrospective survey of a non-surgical approach combining antibiotic therapy with transvenous removal.
abstract: Pacemakers (PMs) and implantable cardioverter defibrillators (ICDs) have become life-saving therapeutic tools for patients with cardiac arrhythmia. Complications include thrombosis, embolism and infections at a highly variable rate. Surgical removal of the infected device has been perceived as the only way to guarantee a successful outcome and to reduce the high risk of mortality. Recently, a transvenous extraction method has been developed to remove infected intracardiac leads without sternotomy. This survey was designed to evaluate the outcome of an approach combining antibiotic therapy with non-surgical transvenous complete removal for the management of cardiac device infections (CDIs). We reviewed case-histories of 121 patients (105 with PM and 16 with ICD infections). The aim of our retrospective survey was to ascertain that a non-invasive transvenous complete removal of the infected devices is safe and effective when associated with appropriate antibiotic therapy starting 10 days before the procedure and extending to at least three weeks after. The infected devices were successfully removed in all patients with a non-surgical transvenous technique. The infections were most frequently caused by coagulase-negative staphylococci (70%), Staphylococcus aureus (14%), and Gram-negative rods (12%). Polymicrobial infections were documented in 19 patients and represent 16% of all device-related infections. The removal of the devices was done during antibiotic therapy, administered for a median of 26 days (range 23 to 45 days). Neither fatalities nor relapse of infections were recorded in the patient population during the one-year follow-up visits. According to our experience, CDIs can be treated with antibiotic therapy and non-surgical removal of the entire infected device, thus allowing a successful reimplantation. This procedure prevents recurrent infections and operative mortality.
authors.affiliation: Infectious Diseases Unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy. c.tascini@ao-pisa.toscana.it
authors.forename: C
authors.initials: C
authors.lastname: Tascini
authors.forename: M G
authors.initials: MG
authors.lastname: Bongiorni
authors.forename: G
authors.initials: G
authors.lastname: Gemignani
authors.forename: E
authors.initials: E
authors.lastname: Soldati
authors.forename: A
authors.initials: A
authors.lastname: Leonildi
authors.forename: G
authors.initials: G
authors.lastname: Arena
authors.forename: R
authors.initials: R
authors.lastname: Doria
authors.forename: G
authors.initials: G
authors.lastname: Giannola
authors.forename: F
authors.initials: F
authors.lastname: La Pira
authors.forename: E
authors.initials: E
authors.lastname: Tagliaferri
authors.forename: P
authors.initials: P
authors.lastname: Caravelli
authors.forename: R
authors.initials: R
authors.lastname: Dell'Anna
authors.forename: F
authors.initials: F
authors.lastname: Menichetti
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000209:etiology / Q000628:therapy*; D003131:Combined Modality Therapy; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D020878:Device Removal; D004697:Endocarditis, Bacterial / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008826:Microbial Sensitivity Tests; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents