Intravascular device infections: epidemiology, diagnosis, and management.
Intravascular devices such as pacemakers, implantable cardioverter-defibrillators (ICDs), left ventricular assist devices (LVADs), and prosthetic vascular grafts are life-saving therapies for patients with malignant arrhythmias, heart failure, and various vascular diseases. As indications for their use have increased, so has the prevalence of infectious complications associated with these devices. We present a review of the clinical literature on the epidemiology, diagnosis, and management of infectious complications of these intravascular devices. Most intravascular device infections are thought to result from skin flora contamination during implantation. Infection of the subcutaneous portion of the device can subsequently track to deeper intravascular tissues. Infection that involves the intravascular or intracardiac portion of these devices carries a high morbidity and mortality. Despite appropriate antibiotic therapy, cure of infection is frequently possible only with device removal. Well-designed placebo-controlled, randomized studies evaluating antimicrobial therapy for treatment of intravascular device infections are lacking. In the absence of better information, authorities recommend antibiotics targeted toward cultured organisms for approximately 4 to 6 weeks and device removal.
Gandelman
Glenn
G
Department of Medicine, the Division of Cardiology, New York Medical College/Westchester Medical Center, Valhalla, New York 10595, USA.
Frishman
William H
WH
Wiese
Cristina
C
Green-Gastwirth
Vanessa
V
Hong
Steven
S
Aronow
Wilbert S
WS
Horowitz
Harold W
HW
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D001807:Blood Vessel Prosthesis / Q000009:adverse effects / Q000382:microbiology*; D017147:Defibrillators, Implantable / Q000009:adverse effects / Q000382:microbiology*; D020878:Device Removal; D005500:Follow-Up Studies; D006353:Heart-Assist Devices / Q000009:adverse effects / Q000382:microbiology*; D006801:Humans; D012307:Risk Factors; D013211:Staphylococcus aureus / Q000472:pathogenicity; D013212:Staphylococcus epidermidis / Q000472:pathogenicity
D000900:Anti-Bacterial Agents