Curing cardiac-device infections

Tuesday 8th May 2007

An aggressive strategy of combined antimicrobial treatment and complete device removal is enough to cure most patients with cardiac device infections (CDIs), US study findings indicate.

It is estimated that over the last decade, the implantation rate of cardiac devices has risen by 42%, and has been associated with a 124% increase in the rate of CDIs. Dr Muhammad Sohail and colleagues from Mayo Clinic College of Medicine in Rochester, Minnesota, point out that, crucially, optimal care of patients with CDIs has not been well defined.

To investigate further, the team examined the records of all 189 patients with CDIs admitted to the Mayo Clinic between 1991 and 2003. Of these, 138 had received a permanent pacemaker while the remainder had been fitted with an implantable cardioverter-defibrillator. The median age of the patients was 71.2 years.

Generator-pocket infection and device-related endocarditis were the most common clinical presentations, seen in 69% and 23% of patients respectively. The leading pathogens were coagulase-negative staphylococci, seen in 42% of cases, and Staphylococcus aureus, which was detected in 29% of patients.

Complete device removal was performed in 98% of patients, and the duration of subsequent antibiotic therapy was determined by clinical presentation and causative organism, at a median duration of 18 days in patients with pocket infection, compared with 28 days in patients with endocarditis, 28 days for in those with S aureus infection and 14 days for those with coagulase-negative staphylococci infection.

Over a median follow-up after hospital discharge of 175 days, 96% of patients who were treated with both complete device removal and antibiotic administration were cured of their CDI, the team notes in the Journal of the American College of Cardiology.

The team proposes a set of guidelines to assist clinicians in the management of patients with CDIs, adding: "These recommendations are not meant to replace individual patient management, however, and consultation with available specialists is advocated."

J Am Coll Cardiol 2007;49:1851-9