title: Preventing cardiac implantable electronic device infections.
abstract: Cardiac implantable electronic devices (CIEDs) have dramatically improved clinical outcomes in patients with heart disease, and the number of CIED-related procedures being performed continues to grow. Unfortunately, the rate of device-related infection (DRI) is increasing disproportionately to the rate of implantation, with DRI rates of >2% in many series. This increase in DRI is a consequence of the increased number of patients with a higher burden of comorbidities, who are more susceptible to infection and are undergoing more complex device procedures. Identification of high-risk patients is an important component of procedural planning, and targeted therapy and surveillance may be beneficial in certain groups. An understanding of the pathophysiology of DRI has facilitated more effective and widespread use of prophylactic antibiotics; however, current guidelines for antibiotic prophylaxis are based on a relatively small evidence base. Clinical equipoise remains regarding the optimal prophylactic regimen, and we are continuing to learn how best to manage these patients. In this review, we discuss the epidemiology and pathophysiology of DRI and its clinical presentation, the risk factors for DRI, and the existing and emerging evidence supporting strategies to prevent DRI.
authors.affiliation: Divisions of Cardiology.
authors.forename: Gareth J
authors.initials: GJ
authors.lastname: Padfield
authors.affiliation: Divisions of Cardiology.
authors.forename: Christian
authors.initials: C
authors.lastname: Steinberg
authors.affiliation: Divisions of Cardiology.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Bennett
authors.affiliation: Divisions of Cardiology.
authors.forename: Santabhanu
authors.initials: S
authors.lastname: Chakrabarti
authors.affiliation: Divisions of Cardiology.
authors.forename: Marc W
authors.initials: MW
authors.lastname: Deyell
authors.affiliation: Divisions of Cardiology; Cardiovascular Surgery, University of British Columbia, Vancouver, Canada.
authors.forename: Jamil
authors.initials: J
authors.lastname: Bashir
authors.affiliation: Divisions of Cardiology. Electronic address: akrahn@mail.ubc.ca.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Krahn
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D016022:Case-Control Studies; D017147:Defibrillators, Implantable / Q000009:adverse effects* / Q000706:statistics & numerical data; D020878:Device Removal / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011322:Primary Prevention / Q000379:methods*; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000401:mortality / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D012086:Reoperation / Q000379:methods; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotics; Cardiac implantable electronic device; Infection; Prevention; Risk stratification