In Reply to ‘Impact of ESRD on Infections of Implantable Cardiac Rhythm Devices’

Abstract

We appreciate the thoughtful comments by Ipek and colleagues1Gucuk Ipek E. Guray Y. Guray U. Impact of ESRD on infections of implantable cardiac rhythm devices.Am J Kidney Dis. 2015; 65: 169Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar regarding our article,2Hickson L.J. Gooden J.Y. Le K.Y. et al.Clinical presentation and outcomes of cardiovascular implantable electronic device infections in hemodialysis patients.Am J Kidney Dis. 2014; 64: 104-110Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar which addresses the impact of chronic kidney failure on infections of cardiovascular implantable electronic devices (CIEDs). We agree with the authors’ concern that hemodialysis patients are at higher risk of hematogenous seeding of cardiac device leads (secondary to catheter-related bloodstream infections) and have a relatively higher frequency of complications related to lead extraction. (Of note, the latter observation was not statistically significant in our analysis, but this likely was due to the small number of cases.) However, while lead extraction–related complications are a concern, medical management alone is associated with an unacceptably higher risk of infection relapse. Infection relapse occurs in 50% to 100% of cases with partial removal of the CIED or antibiotic treatment alone compared to 0% to 4.2% following complete removal of the CIED and its leads.3Chua J.D. Wilkoff B.L. Lee I. Juratli N. Longworth D.L. Gordon S.M. Diagnosis and management of infections involving implantable electrophysiologic cardiac devices.Ann Intern Med. 2000; 133: 604-608Crossref PubMed Scopus (382) Google Scholar, 4del Rio A. Anguera I. Miro J.M. et al.Surgical treatment of pacemaker and defibrillator lead endocarditis: the impact of electrode lead extraction on outcome.Chest. 2003; 124: 1451-1459Crossref PubMed Scopus (201) Google Scholar, 5Klug D. Wallet F. Lacroix D. et al.Local symptoms at the site of pacemaker implantation indicate latent systemic infection.Heart. 2004; 90: 882-886Crossref PubMed Scopus (141) Google Scholar, 6Margey R. McCann H. Blake G. et al.Contemporary management of and outcomes from cardiac device related infections.Europace. 2010; 12: 64-70Crossref PubMed Scopus (124) Google Scholar, 7Sohail M.R. Uslan D.Z. Khan A.H. et al.Management and outcome of permanent pacemaker and implantable cardioverter-defibrillator infections.J Am Coll Cardiol. 2007; 49: 1851-1859Abstract Full Text Full Text PDF PubMed Scopus (525) Google Scholar Therefore, complete removal of the device, including leads, should be the preferred treatment in all patients presenting with device infection unless contraindicated. As concluded by Ipek et al,1Gucuk Ipek E. Guray Y. Guray U. Impact of ESRD on infections of implantable cardiac rhythm devices.Am J Kidney Dis. 2015; 65: 169Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar the need for cardiac rhythm device therapy should be assessed carefully in dialysis patients due to the risk of subsequent infectious complications. Financial Disclosure: Dr Baddour has received royalty (authorship) payments from UpToDate and is an Editor for the Massachusetts Medical Society (NEJM Journal Watch Infectious Diseases). Dr Sohail has received honoraria from and is a consultant for TyRx Pharma Inc. Dr Hickson declares that she has no relevant financial interests. Impact of ESRD on Infections of Implantable Cardiac Rhythm DevicesAmerican Journal of Kidney DiseasesVol. 65Issue 1PreviewWe read with great interest the recently published article by Hickson et al,1 which examined a serious complication of cardiovascular implantable electronic device (CIED) implantation: infection.2 Full-Text PDF