Cardiac implantable electronic device infections: Observational data from a tertiary care center in Lebanon

Abstract

With increasing rates of device implantation, there is an increased recognition of device infection. We conducted a retrospective observational study in a tertiary care center in Lebanon, with data collected from medical records of patients presenting with cardiac implantable electronic device (CIED) infection from 2000 to 2017 with the purpose of identifying etiologies, risk factors and other parameters, and comparing them to available data from the rest of the world. We identified a total of 22 CIED infections. The most common microbial etiologies, including involvement in polymicrobial infection, were coagulase-negative staphylococci (45.5%) and Staphylococcus aureus (22.7%). Rare cases of Brucella melitensis, Sphingomonas paucimobilis, and Kytococcus schroeteri device infection were seen. Heart failure was seen in 77.3% of patients, hypertension in 68.2%, and chronic kidney disease in 50%. Skin changes were the most common presenting symptoms (86.4%). Antibiotics were given to all patients and all had their devices removed, with 36.4% undergoing new device implantation. This is the first study of CIED infections in Lebanon and the Middle East. Local epidemiology and occupational exposure must be considered while contemplating the microbial etiology of infection. Close monitoring after device implantation is important in preventing device infection that carries high risk of morbidity and mortality.

Figure 1

Risk factors and comorbid conditions present in patients presenting with cardiac implantable device infection in tertiary care center in Lebanon from 2000 to 2017.

Figure 2

Cardiac implantable electronic device infection etiologies in 22 recruited patients in tertiary care center in Lebanon.

Figure 3

Positron emission tomography-computed tomography scan of patient presenting with Sphingomonas paucimobilis cardiac implantable electronic device infection.

Figure 4

Skin changes seen in patient presenting with Enterobacter cloacae cardiac implantable electronic device infection (Panels A and B), septic shock and a large vegetation on transesophageal echocardiography (Panel C) on the lead that was surgically removed (Panels D and E).