title: Management of Cardiac Implantable Electronic Device Infection.
abstract: Despite improved preventive measures, infection associated with the use of cardiac implantable electronic devices (CIEDs) to treat often life-threatening conditions is rising at an average annual rate of almost 5 %. This rise is being driven by the increasing complexity of CIED technology and by the advancing age and co-morbidities of the patients. Although CIED infection is usually suspected based on local signs at the generator pocket site, diagnosis can be challenging in patients presenting no local manifestations or symptoms. Diagnostic methods include microbiological testing and echocardiography, and may be completed by positron emission tomography (PET)/computed tomography (CT) scan in selected cases. CIED infection requires a multidisciplinary approach in view of hardware extraction, targeted antibiotic therapy and reimplantation on an as-needed basis. Antibiotic prophylaxis targeting staphylococcal flora is recommended but the relation of these infections to medical care exposes patients to multi-resistant bacteria. New preventive measures utilising an antibacterial sleeve look promising. Treatment can be started on an empirical basis using an antistaphylococcal agent but must be continued using targeted antibiotic therapy. Crucial questions remain as to the best prevention strategy, optimal duration and timing of antibiotic therapy, and the most effective reimplantation technique.
authors.affiliation: Cardiology Department, University of Medicine and Pharmacy Tîrgu Mures, Tîrgu Mures, Romania.
authors.forename: Cristian
authors.initials: C
authors.lastname: Podoleanu
authors.affiliation: Cardiology Department, CHU La Timone, Marseille, France.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Deharo
keywords: Infection; defibrillator; pacemaker
references.citation: JACC Heart Fail. 2013 Dec;1(6):508-13
references.pmid: 24622003
references.citation: Circulation. 2010 Jan 26;121(3):458-77
references.pmid: 20048212
references.citation: Europace. 2012 Nov;14(11):1666-9
references.pmid: 23104858
references.citation: J Am Coll Cardiol. 2013 Apr 2;61(13):1398-405
references.pmid: 23500279
references.citation: Circulation. 2001 Aug 28;104(9):1029-33
references.pmid: 11524397
references.citation: Am J Cardiol. 2013 Mar 15;111(6):874-9
references.pmid: 23276467
references.citation: Ann Intern Med. 2000 Oct 17;133(8):604-8
references.pmid: 11033588
references.citation: Circ Arrhythm Electrophysiol. 2009 Apr;2(2):129-34
references.pmid: 19808457
references.citation: J Am Coll Cardiol. 2011 Aug 30;58(10):1001-6
references.pmid: 21867833
references.citation: J Am Coll Cardiol. 2012 May 1;59(18):1616-25
references.pmid: 22538331
references.citation: Am J Cardiol. 1998 Aug 15;82(4):480-4
references.pmid: 9723637
references.citation: Heart Rhythm. 2011 Nov;8(11):1678-85
references.pmid: 21699855
references.citation: J Am Coll Cardiol. 2007 May 8;49(18):1851-9
references.pmid: 17481444
references.citation: Heart Rhythm. 2009 Jul;6(7):1085-104
references.pmid: 19560098
references.citation: Circulation. 2009 Mar 3;119(8):e223-4
references.pmid: 19255349
references.citation: Mayo Clin Proc. 2008 Jan;83(1):46-53
references.pmid: 18174000
references.citation: N Engl J Med. 2005 Apr 14;352(15):1539-49
references.pmid: 15753115
references.citation: Europace. 2013 Apr;15(4):541-5
references.pmid: 23015633
references.citation: Heart. 2004 Aug;90(8):882-6
references.pmid: 15253959
references.citation: JAMA. 2012 Apr 25;307(16):1727-35
references.pmid: 22535857
references.citation: Europace. 2012 Sep;14(9):1334-9
references.pmid: 22399202
references.citation: Pacing Clin Electrophysiol. 2011 Feb;34(2):150-4
references.pmid: 21070257
references.citation: Circulation. 1997 Apr 15;95(8):2098-107
references.pmid: 9133520
references.citation: Eur Heart J. 2009 Oct;30(19):2369-413
references.pmid: 19713420
references.citation: Circulation. 2010 Apr 20;121(15):1686-7
references.pmid: 20368526
references.citation: Clin Infect Dis. 2004 Jul 1;39(1):68-74
references.pmid: 15206055
references.citation: Arch Intern Med. 2007 Apr 9;167(7):669-75
references.pmid: 17420425
references.citation: Echocardiography. 2008 Jul;25(6):632-8
references.pmid: 18652009
references.citation: Pacing Clin Electrophysiol. 2010 Apr;33(4):414-9
references.pmid: 19793359
references.citation: N Engl J Med. 2012 Aug 30;367(9):842-9
references.pmid: 22931318
references.citation: Europace. 2013 Feb;15(2):252-7
references.pmid: 23148119
references.citation: Europace. 2013 Sep;15(9):1287-91
references.pmid: 23482613
references.citation: Eur Heart J. 2004 Jan;25(1):88-95
references.pmid: 14683747
references.citation: Circ Arrhythm Electrophysiol. 2012 Apr;5(2):433-41
references.pmid: 22511660
references.citation: Heart Rhythm. 2011 Sep;8(9):1478-81
references.pmid: 21463705
references.citation: Pacing Clin Electrophysiol. 2011 Apr;34(4):450-9
references.pmid: 21208230
references.citation: Pacing Clin Electrophysiol. 2009 Jul;32(7):898-907
references.pmid: 19572866
references.citation: J Cardiovasc Electrophysiol. 2010 May;21(5):540-4
references.pmid: 19925606
references.citation: Europace. 2012 Jan;14(1):124-34
references.pmid: 22167387
references.citation: Circulation. 1998 May 12;97(18):1791-5
references.pmid: 9603533
references.citation: Pacing Clin Electrophysiol. 2006 Aug;29(8):875-9
references.pmid: 16923004
references.citation: Heart Rhythm. 2014 Apr;11(4):595-601
references.pmid: 24333543
references.citation: Circulation. 2010 Sep 28;122(13):1265-71
references.pmid: 20837894
references.citation: Clin Infect Dis. 2012 Feb 1;54(3):347-54
references.pmid: 22100575
references.citation: Pacing Clin Electrophysiol. 2011 Feb;34(2):133-42
references.pmid: 20942819
references.citation: Circulation. 2007 Sep 18;116(12):1349-55
references.pmid: 17724263
references.citation: Circulation. 2013 Feb 12;127(6):691-702
references.pmid: 23315371
references.citation: JACC Cardiovasc Imaging. 2010 Jul;3(7):673-81
references.pmid: 20633844
references.citation: Pacing Clin Electrophysiol. 2012 Jan;35(1):81-7
references.pmid: 22077194
references.citation: Europace. 2008 Sep;10(9):1067-72
references.pmid: 18658253
references.citation: Heart. 2012 May;98(9):724-31
references.pmid: 22523057
references.citation: Circ Arrhythm Electrophysiol. 2009 Feb;2(1):29-34
references.pmid: 19808441
references.citation: Pacing Clin Electrophysiol. 2006 Jan;29(1):29-33
references.pmid: 16441714
references.citation: Eur Heart J. 2011 Apr;32(8):991-8
references.pmid: 21252172
references.citation: Heart Rhythm. 2010 Aug;7(8):1043-7
references.pmid: 20470904
references.citation: Pacing Clin Electrophysiol. 2013 Mar;36(3):354-61
references.pmid: 23252988