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Article

Cardiac implantable electronic device infection

Cameron T. Lambert, MD and Khaldoun G. Tarakji, MD, MPH
Cleveland Clinic Journal of Medicine December 2017, 84 (12 suppl 3) 47-53; DOI: https://doi.org/10.3949/ccjm.84.s3.05
Cameron T. Lambert
Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic
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Khaldoun G. Tarakji
Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic
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  • For correspondence: [email protected]
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    Figure 1

    Pocket infection after placement of a cardiac implantable electronic device can present as erythema and drainage (A); swelling, skin necrosis, and eschar formation (B); and erythema, swelling, and bullae formation (C).

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    Figure 2

    In a patient with endocarditis after cardiac implantable electronic device placement, transthoracic echocardiography shows a large vegetation (V) near the right atrium (RA), right ventricle (RV), and across the tricuspid valve (TV). This required surgical extraction of the organized vegetation along with the device and leads.

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    Figure 3

    The TYRX absorbable antibacterial envelope is a mesh coated with the antibiotics rifampin and minocycline, which elute off the mesh within approximately 7 days. The mesh is completely absorbed into the body in about 9 weeks.

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    Figure 4

    A leadless pacemaker in the right ventricle. The left atrial appendage exclusion clip is present.

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    TABLE 1

    Pathogens identified in 816 patients with lead extraction or device removal for CIED infection

    Pathogen%Pathogen%
    MRCoNS18.8Streptococci2.5
    MSCoNS18.8VSE2.8
    MSSA15.8VRE1.4
    MRSA15Anaerobes1.6
    Negative culture13.2Fungal0.9
    Gram negative8.9Mycobacteria0.2
    • CIED = cardiac implantable electronic device; MRSA = methicillin-resistant Staphylococcus aureus; MSSA = methicillin-sensitive Staphylococcus aureus; MRCoNS = methicillin-resistant coagulase-negative staphylococcus; MSCoNS = methicillin-sensitive coagulase-negative staphylococcus; VRE = vancomycin-resistant Enterococcus species; VSE = vancomycin-sensitive Enterococcus species.

    • Data from reference 12.

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Cleveland Clinic Journal of Medicine: 84 (12 suppl 3)
Cleveland Clinic Journal of Medicine
Vol. 84, Issue 12 suppl 3
1 Dec 2017
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Cardiac implantable electronic device infection
Cameron T. Lambert, Khaldoun G. Tarakji
Cleveland Clinic Journal of Medicine Dec 2017, 84 (12 suppl 3) 47-53; DOI: 10.3949/ccjm.84.s3.05

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Cardiac implantable electronic device infection
Cameron T. Lambert, Khaldoun G. Tarakji
Cleveland Clinic Journal of Medicine Dec 2017, 84 (12 suppl 3) 47-53; DOI: 10.3949/ccjm.84.s3.05
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  • Article
    • ABSTRACT
    • SCOPE OF THE PROBLEM
    • PATHOGENESIS
    • DIAGNOSIS
    • MANAGEMENT
    • DEVICE REMOVAL
    • REIMPLANTATION
    • CIED INFECTION MORTALITY
    • PREVENTION
    • CONCLUSION
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