Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Aug 1;19(4):48-57.
doi: 10.14797/mdcvj.1271. eCollection 2023.

Clinical Approach to Evaluation of Underlying Cardiac Device Infection in Patients Hospitalized with Bacteremia

Dierdre B Axell-House  1   2 , Sarwat Khalil  3 , M Rizwan Sohail  3
Affiliations
Review

Clinical Approach to Evaluation of Underlying Cardiac Device Infection in Patients Hospitalized with Bacteremia

Dierdre B Axell-House et al. Methodist Debakey Cardiovasc J. .

Abstract

More than 400,000 cardiac implantable electronic devices (CIEDs), including permanent pacemakers, implantable cardioverter-defibrillators, and cardiac resynchronization therapy devices, are implanted every year in the United States (US). Infection is a serious complication of CIED therapy and is associated with high morbidity and mortality. While CIED pocket infection can be diagnosed based on clinical exam findings, positive blood culture may be the only manifestation of CIED lead infection. Thus, management of bacteremia in patients living with CIEDs requires special consideration. This review summarizes contemporary data in the context of the recently updated 2023 Duke-International Society for Cardiovascular Infectious Diseases Criteria for Infective Endocarditis. We have synthesized these data into an algorithmic approach to streamline the diagnostic evaluation of CIED infection in patients presenting with bacteremia.

Keywords: bacteremia; cardiac implantable electronic devices; hematogenous seeding; infective endocarditis.

PubMed Disclaimer

Conflict of interest statement

Dr. Sohail reports honoraria/consulting fees from Medtronic, Azyio Biologics, and Philips. Drs. Axell-House and Khalil have no competing interests to declare.

Figures

Management of SAB in patients with CIEDs
Figure 1
Management of Staphylococcus aureus bacteremia (SAB) in patients with cardiac implantable electronic devices (CIEDs). BCx: blood cultures; EOT: end of therapy; hr: hour; IV: intravenous; PET-CT: positron emission tomography-computed tomography; TEE: transesophageal echocardiography 1Duration may be extended to 6 weeks in presence of infectious complications requiring prolonged antibiotics such as osteomyelitis and endovascular infection (ie, septic venous thrombosis).
Management of non-SAM gram-positive cocci and gram-positive rod bacteremia in patients with CIEDs
Figure 2
Management of non-S. aureus gram-positive cocci and gram-positive rod bacteremia in patients with cardiac implantable electronic devices. CoNS: coagulase-negative staphylococci; PET-CT: positron emission tomography-computed tomography; TEE: transesophageal echocardiography 1Staphylococcus lugdunensis, Enterococcus faecalis, streptococci except S. pneumoniae and S. pyogenes, Granulicatella spp., Abiotrophia spp., Gemella spp.
Management of gram-negative bacteremia in patients with CIEDs
Figure 3
Management of gram-negative bacteremia in patients with cardiac implantable electronic devices. HACEK: Hemophilus spp., Aggregatibacter spp., Cardiobacterium spp., Eikenella spp., Kingella spp.; PET-CT: positron emission tomography-computed tomography; TEE: transesophageal echocardiography
See this image and copyright information in PMC

References

    1. Buch E, Boyle NG, Belott PH. Pacemaker and defibrillator lead extraction. Circulation. 2011. Mar 22;123(11):e378-80. doi: 10.1161/CIRCULATIONAHA.110.987354 - DOI - PubMed
    1. Dai M, Cai C, Vaibhav V, et al. Trends of Cardiovascular Implantable Electronic Device Infection in 3 Decades: A Population-Based Study. JACC Clin Electrophysiol. 2019. Sep;5(9):1071-1080. doi: 10.1016/j.jacep.2019.06.016 - DOI - PubMed
    1. Sohail MR, Uslan DZ, Khan AH, et al. Management and outcome of permanent pacemaker and implantable cardioverter-defibrillator infections. J Am Coll Cardiol. 2007. May 8;49(18):1851-9. doi: 10.1016/j.jacc.2007.01.072 - DOI - PubMed
    1. Voigt A, Shalaby A, Saba S. Rising rates of cardiac rhythm management device infections in the United States: 1996 through 2003. J Am Coll Cardiol. 2006. Aug 1;48(3):590-1. doi: 10.1016/j.jacc.2006.05.016 - DOI - PubMed
    1. Greenspon AJ, Patel JD, Lau E, et al. 16-year trends in the infection burden for pacemakers and implantable cardioverter-defibrillators in the United States 1993 to 2008. J Am Coll Cardiol. 2011. Aug 30;58(10):1001-6. doi: 10.1016/j.jacc.2011.04.033 - DOI - PubMed

MeSH terms