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

• Published in: Pacing and clinical electrophysiology Vol. 41; no. 5; pp. 524 - 531
• Main Authors: 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.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.05.2018
• Subjects: Aged; cardiovascular implantable electronic device (CIED); Coagulase; Defibrillators, Implantable; Device Removal; Electronic equipment; Female; Humans; ICD; infection; Infections; Laboratories; Male; pacemaker; Pacemaker, Artificial; Prospective Studies; Prosthesis-Related Infections - therapy; Registries; Risk Factors; salvage; Salvage Therapy; Treatment Failure; infection; pacemaker; ICD; salvage; cardiovascular implantable electronic device (CIED)
• ISSN: 0147-8389; 1540-8159
• DOI: 10.1111/pace.13319

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.