TY - JOUR
T1 - Usefulness of Sonication of Cardiovascular Implantable Electronic Devices to Enhance Microbial Detection
AU - Nagpal, Avish
AU - Patel, Robin
AU - Greenwood-Quaintance, Kerryl E.
AU - Baddour, Larry M.
AU - Lynch, David T.
AU - Lahr, Brian D.
AU - Maleszewski, Joseph J.
AU - Friedman, Paul A.
AU - Hayes, David L.
AU - Sohail, M. Rizwan
N1 - Funding Information:
Paul A. Friedman receives honoraria from Medtronic, Guidant, and Astra Zeneca; receives research sponsorship from Medtronic , Astra Zeneca via Beth Israel, Guidant , St. Jude , and Bard ; and has intellectual property rights in Bard EP, Hewlett Packard, and Medical Positioning, Inc. David L. Hayes receives honoraria from Medtronic, Boston Scientific, St. Jude Medical, Sorin Medical, and Biotronik; is in the advisory board of St. Jude Medical and Medtronic; and is in the steering committee of Medtronic and St. Jude Medical. Larry M. Baddour receives royalty payments (authorship) from UpToDate Inc. (<$20,000) and Editor-in-Chief payments from Massachusetts Medical Society (Journal Watch Infectious Diseases; <$20,000). M. Rizwan Sohail received funding from TyRx Inc. for previous research unrelated to this study (Bloom et al. PACE 2011 34, 133–42), administered according to a sponsored research agreement that prospectively defined the scope of the research effort and corresponding budget, and receives honoraria from Medtronic and Spectranetics. Robin Patel has a US patent pending for a method and an apparatus for sonication (has forgone right to receive royalties in the event that the patent is licensed) and patents for an antibiofilm substance and Bordetella pertussis/parapertussis PCR; receives research support (grants, reagents, and equipment loan) from Pfizer , Tornier , Pradama , Astellas , Pocared , 3M , nanoMR , Bruker , Nanosphere , BioFire bioMérieux , Curetis is a consultant in Thermo Fisher Scientific, is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health (Award Number R01 AR056647) and the National Institute of Allergy and Infectious Diseases (Award Number R01 AI091594). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The remaining authors have no disclosures.
Publisher Copyright:
© 2015 Elsevier Inc.
PY - 2015/4/1
Y1 - 2015/4/1
N2 - The cardiovascular implantable electronic device (CIED) infection rate is rising disproportionately to the rate of device implantation. Identification of microorganisms that cause CIED infections is not always achieved using present laboratory techniques. We conducted a prospective study to determine whether device vortexing-sonication followed by culture of the resulting sonicate fluid would enhance microbial detection compared with traditional swab or pocket tissue cultures. Forty-two subjects with noninfected and 35 with infected CIEDs were prospectively enrolled over 12 months. One swab each from the device pocket and device surface, pocket tissue, and the CIED were collected from each patient. Swabs and tissues were cultured using routine methods. The CIED was processed in Ringer's solution using vortexing-sonication and the resultant fluid semiquantitatively cultured. Tissue and swab growth was considered significant when colonies grew on ≥2 quadrants of the culture plate and device was considered significant when ≥20 colonies were isolated from 10 ml of sonicate fluid. In noninfected group, 5% of sonicate fluids yielded significant bacterial growth, compared with 5% of tissue cultures (p = 1.00) and 2% of both pocket and device swab cultures (p = 0.317 each). In infected group, significant bacterial growth was observed in 54% of sonicate fluids, significantly greater than the sensitivities of pocket swab (20%, p = 0.001), device swab (9%, p <0.001), or tissue (9%, p <0.001) culture. In conclusion, vortexing-sonication of CIEDs with semiquantitative culture of the resultant sonicate fluid results in a significant increase in the sensitivity of culture results, compared with swab or tissue cultures.
AB - The cardiovascular implantable electronic device (CIED) infection rate is rising disproportionately to the rate of device implantation. Identification of microorganisms that cause CIED infections is not always achieved using present laboratory techniques. We conducted a prospective study to determine whether device vortexing-sonication followed by culture of the resulting sonicate fluid would enhance microbial detection compared with traditional swab or pocket tissue cultures. Forty-two subjects with noninfected and 35 with infected CIEDs were prospectively enrolled over 12 months. One swab each from the device pocket and device surface, pocket tissue, and the CIED were collected from each patient. Swabs and tissues were cultured using routine methods. The CIED was processed in Ringer's solution using vortexing-sonication and the resultant fluid semiquantitatively cultured. Tissue and swab growth was considered significant when colonies grew on ≥2 quadrants of the culture plate and device was considered significant when ≥20 colonies were isolated from 10 ml of sonicate fluid. In noninfected group, 5% of sonicate fluids yielded significant bacterial growth, compared with 5% of tissue cultures (p = 1.00) and 2% of both pocket and device swab cultures (p = 0.317 each). In infected group, significant bacterial growth was observed in 54% of sonicate fluids, significantly greater than the sensitivities of pocket swab (20%, p = 0.001), device swab (9%, p <0.001), or tissue (9%, p <0.001) culture. In conclusion, vortexing-sonication of CIEDs with semiquantitative culture of the resultant sonicate fluid results in a significant increase in the sensitivity of culture results, compared with swab or tissue cultures.
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U2 - 10.1016/j.amjcard.2015.01.017
DO - 10.1016/j.amjcard.2015.01.017
M3 - Article
C2 - 25779615
AN - SCOPUS:84929502217
VL - 115
SP - 912
EP - 917
JO - American Journal of Cardiology
JF - American Journal of Cardiology
SN - 0002-9149
IS - 7
ER -