Purpose of review: Cardiovascular implantable electronic device (CIED) infections are highly morbid, common, and costly, and rates are increasing (Sohail et al. Arch Intern Med 171(20):1821-8 2011; Voigt et al. J Am Coll Cardiol 48(3):590-1 2006). Factors that contribute to the development of CIED infections include patient factors (comorbid conditions, self-care, microbiome), procedural details (repeat procedure, contamination during procedure, appropriate pre-procedural prep, and antimicrobial use), environmental and organizational factors (patient safety culture, facility barriers, such as lack of space to store essential supplies, quality of environmental cleaning), and microbial factors (type of organism, virulence of organism). Each of these can be specifically targeted with infection prevention interventions.
Recent findings: Basic prevention practices, such as administration of systemic antimicrobials prior to incision and delaying the procedure in the setting of fever or elevated INR, are helpful for day-to-day prevention of cardiac device infections. Small single-center studies provide proof-of-concept that bundled prevention interventions can reduce infections, particularly in outbreak settings. However, data regarding which prevention strategies are the most important is limited as are data regarding the optimal prevention program for day-to-day prevention (Borer et al. Infect Control Hosp Epidemiol 25(6):492-7 2004; Ahsan et al. Europace 16(10):1482-9 2014). Evolution of infection prevention programs to include ambulatory and procedural areas is crucial as healthcare delivery is increasingly provided outside of hospitals and operating rooms. The focus on traditional operating rooms and inpatient care leaves the vast majority of healthcare delivery-including cardiac device implantations in the electrophysiology laboratory-uncovered.
Keywords: Cardiac device infection; Infection prevention and control; Quality improvement; Surveillance.
Real-world effectiveness of infection prevention interventions for reducing procedure-related cardiac device infections: Insights from the veterans affairs clinical assessment reporting and tracking program.Infect Control Hosp Epidemiol. 2019 Aug;40(8):855-862. doi: 10.1017/ice.2019.127. Epub 2019 Jun 4. Infect Control Hosp Epidemiol. 2019. PMID: 31159895
Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee.Am J Infect Control. 1999 Apr;27(2):97-132; quiz 133-4; discussion 96. Am J Infect Control. 1999. PMID: 10196487
Cardiac Implantable Electronic Device Infection: From an Infection Prevention Perspective.Adv Prev Med. 2015;2015:357087. doi: 10.1155/2015/357087. Epub 2015 Oct 13. Adv Prev Med. 2015. PMID: 26550494 Free PMC article. Review.
Management of Cardiac Electronic Device Infections: Challenges and Outcomes.Arrhythm Electrophysiol Rev. 2016;5(3):183-187. doi: 10.15420/aer.2016:21:2. Arrhythm Electrophysiol Rev. 2016. PMID: 28116083 Free PMC article.
Perioperative management for the prevention of bacterial infection in cardiac implantable electronic device placement.J Arrhythm. 2016 Aug;32(4):283-6. doi: 10.1016/j.joa.2015.06.007. Epub 2015 Aug 8. J Arrhythm. 2016. PMID: 27588150 Free PMC article. Review.
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Cardiac implantable electronic device infection in the cardiac referral center in Thailand: incidence, microbiology, risk factors, and outcomes.J Arrhythm. 2018 Sep 27;34(6):632-639. doi: 10.1002/joa3.12123. eCollection 2018 Dec. J Arrhythm. 2018. PMID: 30555607 Free PMC article.