title: Infections in Cardiac Implantable Electronic Devices: Diagnosis and Management in a Referral Center.
abstract: OBJECTIVE
  Infections in cardiac implantable electronic devices are increasing due to the expansion of the indications of these devices. The management of some aspects is controversial. Here, we report our broad experience.
  
  
  METHODS
  Between 1985 and 2015, 325 infections (196 local and 129 systemic) were registered; 28.5% of them were referred from other centers: 229 pacemakers, 69 implantable cardioverter-defibrillators, and 27 patients with cardiac resynchronization therapy. The follow-up was at least 1 year after hospital discharge.
  
  
  RESULTS
  Percutaneous traction (PCT) was the most frequent procedure (n=280) in local (n=166) and systemic infections (n=114), with complete extraction of the system in 82.5% of the patients, clinical success in 89%, and few complications (2 deaths attributable to the technique). Overall mortality was 1% in local infections and 8% in systemic infections. After 212 complete PCT, a new device was placed in 209: of these, a contralateral system was implanted in the same procedure in 152 (73%) and in a second procedure in 57, with no differences in relapses (2 in the 1-stage procedure, and 1 in the 2-stage procedure).
  
  
  CONCLUSIONS
  Percutaneous traction in experienced hands has good results with very few complications. It is possible to perform contralateral implantation of the new device on the same day without increasing the risk of relapse.
authors.affiliation: Servicio de Cirugía Cardiaca, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
authors.forename: Encarnación
authors.initials: E
authors.lastname: Gutiérrez Carretero
authors.affiliation: Unidad de Electrofisiología, Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Arana Rueda
authors.affiliation: Infectious Diseases Department, Oxford University Hospitals, NHS Foundation Trust, United Kingdom.
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Lomas Cabezas
authors.affiliation: Servicio de Cirugía Cardiaca, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Laviana Martínez
authors.affiliation: Unidad de Hemodinámica, Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Villa Gil-Ortega
authors.affiliation: Servicio de Anestesia y Reanimación, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Acosta Martínez
authors.affiliation: Unidad de Electrofisiología, Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
authors.forename: Alonso
authors.initials: A
authors.lastname: Pedrote Martínez
authors.affiliation: Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Grupo de Investigación en Enfermedades Infecciosas, Instituto de Biomedicina de Sevilla, Sevilla, Spain. Electronic address: aa2406ge@yahoo.es.
authors.forename: Arístides
authors.initials: A
authors.lastname: de Alarcón González
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058409:Cardiac Resynchronization Therapy Devices / Q000009:adverse effects*; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D012017:Referral and Consultation; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Defibrillators; Desfibriladores; Extracción percutánea; Infección; Infection; Marcapasos; Pacemakers; Percutaneous lead extraction