title: Cardiovascular implantable electronic device infections in left ventricular assist device recipients.
abstract: BACKGROUND
  Most patients with left ventricular assist devices (LVADs) have concomitant cardiovascular implantable electronic devices (CIEDs). However, clinical presentation and outcome of CIED infection in the setting of LVAD has not been previously described.
  
  
  METHODS
  We retrospectively reviewed 247 patients who underwent LVAD implantation at Mayo Clinic campuses in Minnesota, Arizona, and Florida, from January 2005 to December 2011. Demographic and clinical data of patients who met criteria for CIED infection were extracted.
  
  
  RESULTS
  Of 247 patients with LVADs, 215 (87%) had CIED at the time of LVAD implantation and six (2.8%) subsequently developed CIED infections. Three patients developed CIED lead-related endocarditis and the other three had pocket infection. All three instances of CIED pocket infection were preceded by device generator exchange, whereas all three patients with CIED lead-related endocarditis had prior LVAD-related infections. Causative pathogens included Pseudomonas aeruginos (1), coagulase-negative staphylococci (2), methicillin-resistant Staphylococcus aureus (1), a gram-positive bacillus (1), and culture negative (2). All patients underwent complete CIED removal along with antimicrobial therapy. The three patients with CIED lead-related endocarditis and prior LVAD infections received chronic suppressive antibiotic therapy, and one patient had LVAD exchange. All but one remained alive at the last follow-up with a median duration of 15 months (7-46 months) from the time of CIED infection.
  
  
  CONCLUSIONS
  Patients who are receiving LVAD therapy and develop CIED infection should be managed with complete CIED removal. Chronic suppressive antibiotic therapy is warranted in cases that have concomitant LVAD infection.
authors.affiliation: Division of Infectious Diseases.
authors.forename: Talha
authors.initials: T
authors.lastname: Riaz
authors.forename: Juhsien J C
authors.initials: JJ
authors.lastname: Nienaber
authors.forename: Larry M
authors.initials: LM
authors.lastname: Baddour
authors.forename: Randall C
authors.initials: RC
authors.lastname: Walker
authors.forename: Soon J
authors.initials: SJ
authors.lastname: Park
authors.forename: Muhammad Rizwan
authors.initials: MR
authors.lastname: Sohail
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015984:Causality; D015897:Comorbidity; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D020878:Device Removal / Q000706:statistics & numerical data; D005260:Female; D005431:Florida / Q000453:epidemiology; D006333:Heart Failure / Q000453:epidemiology* / Q000517:prevention & control*; D006353:Heart-Assist Devices / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D016459:Prosthesis-Related Infections / Q000453:epidemiology* / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: CRT; congestive heart failure; defibrillation - ICD; heart transplantation