title: Reimplantation and Repeat Infection After Cardiac-Implantable Electronic Device Infections: Experience From the MEDIC (Multicenter Electrophysiologic Device Infection Cohort) Database.
abstract: BACKGROUND
  Infection is a serious complication of cardiovascular-implantable electronic device implantation and necessitates removal of all hardware for optimal treatment. Strategies for reimplanting hardware after infection vary widely and have not previously been analyzed using a large, multicenter study.
  
  
  RESULTS
  The MEDIC (Multicenter Electrophysiologic Device Infection Cohort) prospectively enrolled subjects with cardiovascular-implantable electronic device infections at multiple institutions in the United States and abroad between 2009 and 2012. Reimplantation strategies were evaluated overall, and every patient who relapsed within 6 months was individually examined for clinical information that could help explain the negative outcome. Overall, 434 patients with cardiovascular-implantable electronic device infections were prospectively enrolled at participating centers. During the initial course of therapy, complete device removal was done in 381 patients (87.8%), and 220 of them (57.7%) were ultimately reimplanted with new devices. Overall, the median time between removal and reimplantation was 10 days, with an interquartile range of 6 to 19 days. Eleven of the 434 patients had another infection within 6 months, but only 4 of them were managed with cardiovascular-implantable electronic device removal and reimplantation during the initial infection. Thus, the repeat infection rate was low (1.8%) in those who were reimplanted. Patients who retained original hardware had a 11.3% repeat infection rate.
  
  
  CONCLUSIONS
  Our study findings confirm that a broad range of reimplant strategies are used in clinical practice. They suggest that it is safe to reimplant cardiac devices after extraction of previously infected hardware and that the risk of a second infection is low, regardless of reimplant timing.
authors.affiliation: From the Department of Surgery, Division of Cardiothoracic Surgery, University of Miami, FL (T.A.B.); Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at University of California, Los Angeles (D.Z.U.); Department of Medicine, Division of Cardiology, University of Washington, Seattle (J.M.P.); Department of Medicine, Division of Cardiology, Cardiac Electrophysiology Laboratory, Thomas Jefferson University Hospital, Philadelphia, PA (A.J.G.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic College of Medicine, Rochester, MN (L.M.B., K.L., M.R.S.); Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Boston (S.B.D.); Department of Medicine, Division of Infectious Diseases, Hospital Clinic, IDIBAPS, University of Barcelona, Spain (J.M.T., J.M.M.); Department of Medicine, Division of Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC (J.P.); and Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Phoenix, AZ (H.R.V.). tab127@miami.edu rcarrillo@med.miami.edu.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Boyle
authors.affiliation: From the Department of Surgery, Division of Cardiothoracic Surgery, University of Miami, FL (T.A.B.); Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at University of California, Los Angeles (D.Z.U.); Department of Medicine, Division of Cardiology, University of Washington, Seattle (J.M.P.); Department of Medicine, Division of Cardiology, Cardiac Electrophysiology Laboratory, Thomas Jefferson University Hospital, Philadelphia, PA (A.J.G.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic College of Medicine, Rochester, MN (L.M.B., K.L., M.R.S.); Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Boston (S.B.D.); Department of Medicine, Division of Infectious Diseases, Hospital Clinic, IDIBAPS, University of Barcelona, Spain (J.M.T., J.M.M.); Department of Medicine, Division of Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC (J.P.); and Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Phoenix, AZ (H.R.V.).
authors.forename: Daniel Z
authors.initials: DZ
authors.lastname: Uslan
authors.affiliation: From the Department of Surgery, Division of Cardiothoracic Surgery, University of Miami, FL (T.A.B.); Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at University of California, Los Angeles (D.Z.U.); Department of Medicine, Division of Cardiology, University of Washington, Seattle (J.M.P.); Department of Medicine, Division of Cardiology, Cardiac Electrophysiology Laboratory, Thomas Jefferson University Hospital, Philadelphia, PA (A.J.G.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic College of Medicine, Rochester, MN (L.M.B., K.L., M.R.S.); Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Boston (S.B.D.); Department of Medicine, Division of Infectious Diseases, Hospital Clinic, IDIBAPS, University of Barcelona, Spain (J.M.T., J.M.M.); Department of Medicine, Division of Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC (J.P.); and Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Phoenix, AZ (H.R.V.).
authors.forename: Jordan M
authors.initials: JM
authors.lastname: Prutkin
authors.affiliation: From the Department of Surgery, Division of Cardiothoracic Surgery, University of Miami, FL (T.A.B.); Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at University of California, Los Angeles (D.Z.U.); Department of Medicine, Division of Cardiology, University of Washington, Seattle (J.M.P.); Department of Medicine, Division of Cardiology, Cardiac Electrophysiology Laboratory, Thomas Jefferson University Hospital, Philadelphia, PA (A.J.G.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic College of Medicine, Rochester, MN (L.M.B., K.L., M.R.S.); Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Boston (S.B.D.); Department of Medicine, Division of Infectious Diseases, Hospital Clinic, IDIBAPS, University of Barcelona, Spain (J.M.T., J.M.M.); Department of Medicine, Division of Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC (J.P.); and Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Phoenix, AZ (H.R.V.).
authors.forename: Arnold J
authors.initials: AJ
authors.lastname: Greenspon
authors.affiliation: From the Department of Surgery, Division of Cardiothoracic Surgery, University of Miami, FL (T.A.B.); Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at University of California, Los Angeles (D.Z.U.); Department of Medicine, Division of Cardiology, University of Washington, Seattle (J.M.P.); Department of Medicine, Division of Cardiology, Cardiac Electrophysiology Laboratory, Thomas Jefferson University Hospital, Philadelphia, PA (A.J.G.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic College of Medicine, Rochester, MN (L.M.B., K.L., M.R.S.); Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Boston (S.B.D.); Department of Medicine, Division of Infectious Diseases, Hospital Clinic, IDIBAPS, University of Barcelona, Spain (J.M.T., J.M.M.); Department of Medicine, Division of Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC (J.P.); and Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Phoenix, AZ (H.R.V.).
authors.forename: Larry M
authors.initials: LM
authors.lastname: Baddour
authors.affiliation: From the Department of Surgery, Division of Cardiothoracic Surgery, University of Miami, FL (T.A.B.); Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at University of California, Los Angeles (D.Z.U.); Department of Medicine, Division of Cardiology, University of Washington, Seattle (J.M.P.); Department of Medicine, Division of Cardiology, Cardiac Electrophysiology Laboratory, Thomas Jefferson University Hospital, Philadelphia, PA (A.J.G.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic College of Medicine, Rochester, MN (L.M.B., K.L., M.R.S.); Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Boston (S.B.D.); Department of Medicine, Division of Infectious Diseases, Hospital Clinic, IDIBAPS, University of Barcelona, Spain (J.M.T., J.M.M.); Department of Medicine, Division of Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC (J.P.); and Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Phoenix, AZ (H.R.V.).
authors.forename: Stephan B
authors.initials: SB
authors.lastname: Danik
authors.affiliation: From the Department of Surgery, Division of Cardiothoracic Surgery, University of Miami, FL (T.A.B.); Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at University of California, Los Angeles (D.Z.U.); Department of Medicine, Division of Cardiology, University of Washington, Seattle (J.M.P.); Department of Medicine, Division of Cardiology, Cardiac Electrophysiology Laboratory, Thomas Jefferson University Hospital, Philadelphia, PA (A.J.G.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic College of Medicine, Rochester, MN (L.M.B., K.L., M.R.S.); Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Boston (S.B.D.); Department of Medicine, Division of Infectious Diseases, Hospital Clinic, IDIBAPS, University of Barcelona, Spain (J.M.T., J.M.M.); Department of Medicine, Division of Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC (J.P.); and Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Phoenix, AZ (H.R.V.).
authors.forename: Jose M
authors.initials: JM
authors.lastname: Tolosana
authors.affiliation: From the Department of Surgery, Division of Cardiothoracic Surgery, University of Miami, FL (T.A.B.); Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at University of California, Los Angeles (D.Z.U.); Department of Medicine, Division of Cardiology, University of Washington, Seattle (J.M.P.); Department of Medicine, Division of Cardiology, Cardiac Electrophysiology Laboratory, Thomas Jefferson University Hospital, Philadelphia, PA (A.J.G.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic College of Medicine, Rochester, MN (L.M.B., K.L., M.R.S.); Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Boston (S.B.D.); Department of Medicine, Division of Infectious Diseases, Hospital Clinic, IDIBAPS, University of Barcelona, Spain (J.M.T., J.M.M.); Department of Medicine, Division of Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC (J.P.); and Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Phoenix, AZ (H.R.V.).
authors.forename: Katherine
authors.initials: K
authors.lastname: Le
authors.affiliation: From the Department of Surgery, Division of Cardiothoracic Surgery, University of Miami, FL (T.A.B.); Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at University of California, Los Angeles (D.Z.U.); Department of Medicine, Division of Cardiology, University of Washington, Seattle (J.M.P.); Department of Medicine, Division of Cardiology, Cardiac Electrophysiology Laboratory, Thomas Jefferson University Hospital, Philadelphia, PA (A.J.G.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic College of Medicine, Rochester, MN (L.M.B., K.L., M.R.S.); Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Boston (S.B.D.); Department of Medicine, Division of Infectious Diseases, Hospital Clinic, IDIBAPS, University of Barcelona, Spain (J.M.T., J.M.M.); Department of Medicine, Division of Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC (J.P.); and Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Phoenix, AZ (H.R.V.).
authors.forename: Jose M
authors.initials: JM
authors.lastname: Miro
authors.affiliation: From the Department of Surgery, Division of Cardiothoracic Surgery, University of Miami, FL (T.A.B.); Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at University of California, Los Angeles (D.Z.U.); Department of Medicine, Division of Cardiology, University of Washington, Seattle (J.M.P.); Department of Medicine, Division of Cardiology, Cardiac Electrophysiology Laboratory, Thomas Jefferson University Hospital, Philadelphia, PA (A.J.G.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic College of Medicine, Rochester, MN (L.M.B., K.L., M.R.S.); Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Boston (S.B.D.); Department of Medicine, Division of Infectious Diseases, Hospital Clinic, IDIBAPS, University of Barcelona, Spain (J.M.T., J.M.M.); Department of Medicine, Division of Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC (J.P.); and Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Phoenix, AZ (H.R.V.).
authors.forename: James
authors.initials: J
authors.lastname: Peacock
authors.affiliation: From the Department of Surgery, Division of Cardiothoracic Surgery, University of Miami, FL (T.A.B.); Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at University of California, Los Angeles (D.Z.U.); Department of Medicine, Division of Cardiology, University of Washington, Seattle (J.M.P.); Department of Medicine, Division of Cardiology, Cardiac Electrophysiology Laboratory, Thomas Jefferson University Hospital, Philadelphia, PA (A.J.G.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic College of Medicine, Rochester, MN (L.M.B., K.L., M.R.S.); Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Boston (S.B.D.); Department of Medicine, Division of Infectious Diseases, Hospital Clinic, IDIBAPS, University of Barcelona, Spain (J.M.T., J.M.M.); Department of Medicine, Division of Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC (J.P.); and Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Phoenix, AZ (H.R.V.).
authors.forename: Muhammad R
authors.initials: MR
authors.lastname: Sohail
authors.affiliation: From the Department of Surgery, Division of Cardiothoracic Surgery, University of Miami, FL (T.A.B.); Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at University of California, Los Angeles (D.Z.U.); Department of Medicine, Division of Cardiology, University of Washington, Seattle (J.M.P.); Department of Medicine, Division of Cardiology, Cardiac Electrophysiology Laboratory, Thomas Jefferson University Hospital, Philadelphia, PA (A.J.G.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic College of Medicine, Rochester, MN (L.M.B., K.L., M.R.S.); Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Boston (S.B.D.); Department of Medicine, Division of Infectious Diseases, Hospital Clinic, IDIBAPS, University of Barcelona, Spain (J.M.T., J.M.M.); Department of Medicine, Division of Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC (J.P.); and Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Phoenix, AZ (H.R.V.).
authors.forename: Holenarasipur R
authors.initials: HR
authors.lastname: Vikram
authors.affiliation: From the Department of Surgery, Division of Cardiothoracic Surgery, University of Miami, FL (T.A.B.); Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at University of California, Los Angeles (D.Z.U.); Department of Medicine, Division of Cardiology, University of Washington, Seattle (J.M.P.); Department of Medicine, Division of Cardiology, Cardiac Electrophysiology Laboratory, Thomas Jefferson University Hospital, Philadelphia, PA (A.J.G.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic College of Medicine, Rochester, MN (L.M.B., K.L., M.R.S.); Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Boston (S.B.D.); Department of Medicine, Division of Infectious Diseases, Hospital Clinic, IDIBAPS, University of Barcelona, Spain (J.M.T., J.M.M.); Department of Medicine, Division of Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC (J.P.); and Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Phoenix, AZ (H.R.V.). tab127@miami.edu rcarrillo@med.miami.edu.
authors.forename: Roger G
authors.initials: RG
authors.lastname: Carrillo
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000628:therapy*; D053821:Cardiovascular Infections / Q000175:diagnosis / Q000628:therapy; D015331:Cohort Studies; D016208:Databases, Factual; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D020878:Device Removal / Q000379:methods*; D055724:Electrophysiological Phenomena; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D012008:Recurrence; D019233:Retreatment / Q000379:methods; D018570:Risk Assessment; D016896:Treatment Outcome; D014481:United States
keywords: cardiovascular infection; device infection; electrophysiology; lead extraction; lead management