Cardiac device infection: Review based in the experience of a single center

Abstract

Introduction: The incidence of cardiac implantable electronic device infections has increased significantly over the years and they are associated with significant morbidity and mortality. The epidemiology in the Central region of Portugal is not known.

Objective and methods: To characterize cardiac implantable electronic device infections through a retrospective study of 3158 patients admitted to our center between January 2008 and September 2014 and to review the subject in the light of the current state of the art.

Results: The infection rate was 1.48% (pacemakers 1.21%, cardiac defibrillator/resynchronization devices 5.40%). The study population consisted of 47 patients with a mean age of 65±19 years, predominantly male (72.3%). Infections were mainly of pacemakers, the main device implanted in our population (n=2954), and most occurred late after first implantation. Clinically, most patients presented with fever and local inflammation. Blood cultures identified mainly Gram-positive microorganisms. Empiric antibiotic therapy with vancomycin was instituted in all patients, associated with gentamicin in 57%. The device was extracted in the majority of cases (72%). During follow-up (32±22 months) eight patients died (17%), seven of cardiovascular cause (15%), and seven were readmitted with device infection (15%).

Conclusions: Our rate of infection was low, similar to other published series, with a higher rate in cardiac defibrillator/resynchronization devices. After standard treatment with antibiotic therapy and device extraction, the prognosis was good.

Keywords: Cardiac defibrillator; Cardiac device; Cardiodesfibrilhador implantáveis; Dispositivos cardíacos; Dispositivos de ressincronização; Endocardite infeciosa; Endocarditis; Pacemakers; Resynchronization device.