Cardiac implantable electronic device infection: Does the device need to be extracted?

Abstract

BackgroundCardiac implantable electronic devices (CIED) have become a common treatment modality in clinical practice. The increase in utilization of these devices has been associated with an increase in infection rates. Published guidelines define when a device is deemed infected (CDI); recommendations for the work‐up of CDI and criteria for extraction. Few data exist as to adherence to these guidelines.ObjectiveWe wanted to o evaluate whether devices diagnosed as CDI fit guidelines, whether clinicians followed work‐up recommendation of CDI, and whether CIED was extracted according to the guidelines criteria in our hospital.MethodsA retrospective review was performed in our hospital between 2008 and 2017. Adult patients (pts) 18 years and older who had their device extracted (DE) with a diagnosis of CDI were included. A total of 95 pts were identified.ResultsWe included 95 pts who were diagnosed as having CDI and who had their DE. Work‐up of patients with a diagnosis of CDI was inconsistently followed. Blood cultures, Echocardiogram, lead cultures (LC), and device pocket cultures (PC) were done in 100%, 90.5%, 75.6%, and 49.3%, respectively. Thirty out of 90 pts. (33%) did not meet guidelines criteria for extraction.ConclusionsIn our institution, a one third of the pts diagnosed with CDI who had DE had no indication for DE per guidelines recommendations. Clinicians did not follow recommendations for work‐up of CDI consistently. Low adherence was seen in obtaining LC and PC. CIED extraction guidelines should be followed to prevent unnecessary complications and cost.