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An aggressive strategy of combined antimicrobial treatment andcomplete device removal is enough to cure most patients with cardiacdevice infections (CDIs), US study findings indicate.
It isestimated that over the last decade, the implantation rate of cardiacdevices has risen by 42%, and has been associated with a 124% increasein the rate of CDIs. Dr Muhammad Sohail and colleagues from Mayo ClinicCollege of Medicine in Rochester, Minnesota, point out that, crucially,optimal care of patients with CDIs has not been well defined.
Toinvestigate further, the team examined the records of all 189 patientswith CDIs admitted to the Mayo Clinic between 1991 and 2003. Of these,138 had received a permanent pacemaker while the remainder had beenfitted with an implantable cardioverter-defibrillator. The median ageof the patients was 71.2 years.
Generator-pocket infectionand device-related endocarditis were the most common clinicalpresentations, seen in 69% and 23% of patients respectively. Theleading pathogens were coagulase-negative staphylococci, seen in 42% ofcases, and Staphylococcus aureus, which was detected in 29% of patients.
Completedevice removal was performed in 98% of patients, and the duration ofsubsequent antibiotic therapy was determined by clinical presentationand causative organism, at a median duration of 18 days in patientswith pocket infection, compared with 28 days in patients withendocarditis, 28 days for in those with S aureus infection and 14 days for those with coagulase-negative staphylococci infection.
Overa median follow-up after hospital discharge of 175 days, 96% ofpatients who were treated with both complete device removal andantibiotic administration were cured of their CDI, the team notes inthe Journal of the American College of Cardiology.
Theteam proposes a set of guidelines to assist clinicians in themanagement of patients with CDIs, adding: “These recommendations arenot meant to replace individual patient management, however, andconsultation with available specialists is advocated.”
J Am Coll Cardiol 2007;49:1851-9