Attempted salvage of infected cardiovascular implantable electronic devices: Are there clinical factors that predict success?

James E. Peacock, Jeanette M. Stafford, Katherine Le, Muhammad Rizwan Sohail, Larry M. Baddour, Jordan M. Prutkin, Stephan B. Danik, Holenarasipur R. Vikram, Marta Hernandez-Meneses, José M. Miró, Elisabeth Blank, Christoph K. Naber, Roger G. Carrillo, Arnold J. Greenspon, Chi Hong Tseng, Daniel Z. Uslan

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: Published guidelines mandate complete device removal in cases of cardiovascular implantable electronic device (CIED) infection. Clinical predictors of successful salvage of infected CIEDs have not been defined. Methods: Data from the Multicenter Electrophysiologic Device Infection Collaboration, a prospective, observational, multinational cohort study of CIED infection, were used to investigate whether clinical predictors of successful salvage of infected devices could be identified. Results: Of 433 adult patients with CIED infections, 306 (71%) underwent immediate device explantation. Medical management with device retention and antimicrobial therapy was initially attempted in 127 patients (29%). "Early failure" of attempted salvage occurred in 74 patients (58%) who subsequently underwent device explantation during the index hospitalization. The remaining 53 patients (42%) in the attempted salvage group retained their CIED. Twenty-six (49%) had resolution of CIED infection (successful salvage group) whereas 27 patients (51%) experienced "late" salvage failure. Upon comparing the salvage failure group, early and late (N = 101), to the group experiencing successful salvage of an infected CIED (N = 26), no clinical or laboratory predictors of successful salvage were identified. However, by univariate analysis, coagulase-negative staphylococci as infecting pathogens (P = 0.0439) and the presence of a lead vegetation (P = 0.024) were associated with overall failed salvage. Conclusions: In patients with definite CIED infections, clinical and laboratory variables cannot predict successful device salvage. Until new data are forthcoming, device explantation should remain a mandatory and early management intervention in patients with CIED infection in keeping with existing expert guidelines unless medical contraindications exist or patients refuse device removal.

Original languageEnglish (US)
JournalPACE - Pacing and Clinical Electrophysiology
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Equipment and Supplies
Infection
Device Removal
Laboratory Infection
Guidelines
Coagulase
Staphylococcus
Hospitalization
Cohort Studies

Keywords

  • Cardiovascular implantable electronic device (CIED)
  • ICD
  • Infection
  • Pacemaker
  • Salvage

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Attempted salvage of infected cardiovascular implantable electronic devices : Are there clinical factors that predict success? / Peacock, James E.; Stafford, Jeanette M.; Le, Katherine; Sohail, Muhammad Rizwan; Baddour, Larry M.; Prutkin, Jordan M.; Danik, Stephan B.; Vikram, Holenarasipur R.; Hernandez-Meneses, Marta; Miró, José M.; Blank, Elisabeth; Naber, Christoph K.; Carrillo, Roger G.; Greenspon, Arnold J.; Tseng, Chi Hong; Uslan, Daniel Z.

In: PACE - Pacing and Clinical Electrophysiology, 01.01.2018.

Research output: Contribution to journalArticle

Peacock, JE, Stafford, JM, Le, K, Sohail, MR, Baddour, LM, Prutkin, JM, Danik, SB, Vikram, HR, Hernandez-Meneses, M, Miró, JM, Blank, E, Naber, CK, Carrillo, RG, Greenspon, AJ, Tseng, CH & Uslan, DZ 2018, 'Attempted salvage of infected cardiovascular implantable electronic devices: Are there clinical factors that predict success?', PACE - Pacing and Clinical Electrophysiology. https://doi.org/10.1111/pace.13319
Peacock, James E. ; Stafford, Jeanette M. ; Le, Katherine ; Sohail, Muhammad Rizwan ; Baddour, Larry M. ; Prutkin, Jordan M. ; Danik, Stephan B. ; Vikram, Holenarasipur R. ; Hernandez-Meneses, Marta ; Miró, José M. ; Blank, Elisabeth ; Naber, Christoph K. ; Carrillo, Roger G. ; Greenspon, Arnold J. ; Tseng, Chi Hong ; Uslan, Daniel Z. / Attempted salvage of infected cardiovascular implantable electronic devices : Are there clinical factors that predict success?. In: PACE - Pacing and Clinical Electrophysiology. 2018.
@article{ce018dd32c6d40c6815973d3275fd2e5,
title = "Attempted salvage of infected cardiovascular implantable electronic devices: Are there clinical factors that predict success?",
abstract = "Background: Published guidelines mandate complete device removal in cases of cardiovascular implantable electronic device (CIED) infection. Clinical predictors of successful salvage of infected CIEDs have not been defined. Methods: Data from the Multicenter Electrophysiologic Device Infection Collaboration, a prospective, observational, multinational cohort study of CIED infection, were used to investigate whether clinical predictors of successful salvage of infected devices could be identified. Results: Of 433 adult patients with CIED infections, 306 (71{\%}) underwent immediate device explantation. Medical management with device retention and antimicrobial therapy was initially attempted in 127 patients (29{\%}). {"}Early failure{"} of attempted salvage occurred in 74 patients (58{\%}) who subsequently underwent device explantation during the index hospitalization. The remaining 53 patients (42{\%}) in the attempted salvage group retained their CIED. Twenty-six (49{\%}) had resolution of CIED infection (successful salvage group) whereas 27 patients (51{\%}) experienced {"}late{"} salvage failure. Upon comparing the salvage failure group, early and late (N = 101), to the group experiencing successful salvage of an infected CIED (N = 26), no clinical or laboratory predictors of successful salvage were identified. However, by univariate analysis, coagulase-negative staphylococci as infecting pathogens (P = 0.0439) and the presence of a lead vegetation (P = 0.024) were associated with overall failed salvage. Conclusions: In patients with definite CIED infections, clinical and laboratory variables cannot predict successful device salvage. Until new data are forthcoming, device explantation should remain a mandatory and early management intervention in patients with CIED infection in keeping with existing expert guidelines unless medical contraindications exist or patients refuse device removal.",
keywords = "Cardiovascular implantable electronic device (CIED), ICD, Infection, Pacemaker, Salvage",
author = "Peacock, {James E.} and Stafford, {Jeanette M.} and Katherine Le and Sohail, {Muhammad Rizwan} and Baddour, {Larry M.} and Prutkin, {Jordan M.} and Danik, {Stephan B.} and Vikram, {Holenarasipur R.} and Marta Hernandez-Meneses and Mir{\'o}, {Jos{\'e} M.} and Elisabeth Blank and Naber, {Christoph K.} and Carrillo, {Roger G.} and Greenspon, {Arnold J.} and Tseng, {Chi Hong} and Uslan, {Daniel Z.}",
year = "2018",
month = "1",
day = "1",
doi = "10.1111/pace.13319",
language = "English (US)",
journal = "PACE - Pacing and Clinical Electrophysiology",
issn = "0147-8389",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Attempted salvage of infected cardiovascular implantable electronic devices

T2 - Are there clinical factors that predict success?

AU - Peacock, James E.

AU - Stafford, Jeanette M.

AU - Le, Katherine

AU - Sohail, Muhammad Rizwan

AU - Baddour, Larry M.

AU - Prutkin, Jordan M.

AU - Danik, Stephan B.

AU - Vikram, Holenarasipur R.

AU - Hernandez-Meneses, Marta

AU - Miró, José M.

AU - Blank, Elisabeth

AU - Naber, Christoph K.

AU - Carrillo, Roger G.

AU - Greenspon, Arnold J.

AU - Tseng, Chi Hong

AU - Uslan, Daniel Z.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Published guidelines mandate complete device removal in cases of cardiovascular implantable electronic device (CIED) infection. Clinical predictors of successful salvage of infected CIEDs have not been defined. Methods: Data from the Multicenter Electrophysiologic Device Infection Collaboration, a prospective, observational, multinational cohort study of CIED infection, were used to investigate whether clinical predictors of successful salvage of infected devices could be identified. Results: Of 433 adult patients with CIED infections, 306 (71%) underwent immediate device explantation. Medical management with device retention and antimicrobial therapy was initially attempted in 127 patients (29%). "Early failure" of attempted salvage occurred in 74 patients (58%) who subsequently underwent device explantation during the index hospitalization. The remaining 53 patients (42%) in the attempted salvage group retained their CIED. Twenty-six (49%) had resolution of CIED infection (successful salvage group) whereas 27 patients (51%) experienced "late" salvage failure. Upon comparing the salvage failure group, early and late (N = 101), to the group experiencing successful salvage of an infected CIED (N = 26), no clinical or laboratory predictors of successful salvage were identified. However, by univariate analysis, coagulase-negative staphylococci as infecting pathogens (P = 0.0439) and the presence of a lead vegetation (P = 0.024) were associated with overall failed salvage. Conclusions: In patients with definite CIED infections, clinical and laboratory variables cannot predict successful device salvage. Until new data are forthcoming, device explantation should remain a mandatory and early management intervention in patients with CIED infection in keeping with existing expert guidelines unless medical contraindications exist or patients refuse device removal.

AB - Background: Published guidelines mandate complete device removal in cases of cardiovascular implantable electronic device (CIED) infection. Clinical predictors of successful salvage of infected CIEDs have not been defined. Methods: Data from the Multicenter Electrophysiologic Device Infection Collaboration, a prospective, observational, multinational cohort study of CIED infection, were used to investigate whether clinical predictors of successful salvage of infected devices could be identified. Results: Of 433 adult patients with CIED infections, 306 (71%) underwent immediate device explantation. Medical management with device retention and antimicrobial therapy was initially attempted in 127 patients (29%). "Early failure" of attempted salvage occurred in 74 patients (58%) who subsequently underwent device explantation during the index hospitalization. The remaining 53 patients (42%) in the attempted salvage group retained their CIED. Twenty-six (49%) had resolution of CIED infection (successful salvage group) whereas 27 patients (51%) experienced "late" salvage failure. Upon comparing the salvage failure group, early and late (N = 101), to the group experiencing successful salvage of an infected CIED (N = 26), no clinical or laboratory predictors of successful salvage were identified. However, by univariate analysis, coagulase-negative staphylococci as infecting pathogens (P = 0.0439) and the presence of a lead vegetation (P = 0.024) were associated with overall failed salvage. Conclusions: In patients with definite CIED infections, clinical and laboratory variables cannot predict successful device salvage. Until new data are forthcoming, device explantation should remain a mandatory and early management intervention in patients with CIED infection in keeping with existing expert guidelines unless medical contraindications exist or patients refuse device removal.

KW - Cardiovascular implantable electronic device (CIED)

KW - ICD

KW - Infection

KW - Pacemaker

KW - Salvage

UR - http://www.scopus.com/inward/record.url?scp=85044864822&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85044864822&partnerID=8YFLogxK

U2 - 10.1111/pace.13319

DO - 10.1111/pace.13319

M3 - Article

AN - SCOPUS:85044864822

JO - PACE - Pacing and Clinical Electrophysiology

JF - PACE - Pacing and Clinical Electrophysiology

SN - 0147-8389

ER -