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Muhammad R Sohail - One of the best experts on this subject based on the ideXlab platform.
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impact of abandoned leads on cardiovascular implantable electronic Device Infections a propensity matched analysis of medic multicenter electrophysiologic Device Infection cohort
JACC: Clinical Electrophysiology, 2017Co-Authors: Thomas A Boyle, Larry M Baddour, Jordan M Prutkin, Daniel Z Uslan, Arnold J Greenspon, Stephan B Danik, Jose Maria Tolosana, Jose M Miro, James E Peacock, Muhammad R SohailAbstract:Abstract Objectives This study sought to evaluate the impact of abandoned cardiovascular implantable electronic Device (CIED) leads on the presentation and management of Device-related Infections. Background Device Infection is a serious consequence of CIEDs and necessitates removal of all hardware for attempted cure. The merits of extracting or retaining presumed sterile but nonfunctioning leads is a subject of ongoing debate. Methods The MEDIC (Multicenter Electrophysiologic Device Infection Cohort) prospectively enrolled patients with CIED Infections at 10 institutions in the United States and abroad between January 1, 2009, and December 31, 2012. Within a propensity-matched cohort, relevant clinical information was compared between patients who had 1 or more abandoned leads at the time of Infection and those who had none. Results Matching produced a cohort of 264 patients, including 176 with no abandoned leads and 88 with abandoned leads. The groups were balanced with respect to Charlson comorbidity index, oldest lead age, Device type, sex, and race. At the time of admission, those with abandoned leads were less likely to demonstrate systemic signs of Infection, including leukocytosis (p = 0.023) and positive blood cultures (p = 0.005). Conversely, patients with abandoned leads were more likely to demonstrate local signs of Infections, including skin erosion (p = 0.031) and positive pocket cultures (p = 0.015). In addition, patients with abandoned leads were more likely to require laser extraction (p = 0.010). Conclusions The results of a large prospective registry of CIED Infections demonstrated that patients with abandoned leads may present with different signs, symptoms, and microbiological findings and require laser extraction more than those without abandoned leads.
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reimplantation and repeat Infection after cardiac implantable electronic Device Infections experience from the medic multicenter electrophysiologic Device Infection cohort database
Circulation-arrhythmia and Electrophysiology, 2017Co-Authors: Thomas A Boyle, Larry M Baddour, Jordan M Prutkin, Daniel Z Uslan, Arnold J Greenspon, Stephan B Danik, Jose Maria Tolosana, Jose M Miro, James E Peacock, Muhammad R SohailAbstract:Background—Infection is a serious complication of cardiovascular-implantable electronic Device implantation and necessitates removal of all hardware for optimal treatment. Strategies for reimplanti...
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Cardiovascular implantable electronic Device Infection: A stepwise approach to diagnosis and management
Cleveland Clinic Journal of Medicine, 2011Co-Authors: Ala S. Dababneh, Muhammad R SohailAbstract:Infection related to cardiovascular implantable electronic Devices is a serious complication, necessitating removal of the Device and prolonged parenteral antibiotic therapy. Accurate diagnosis and optimal management of these Infections are challenging. This review highlights the critical management decisions.
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abstract 2490 cardiovascular implantable electronic Device Infection in patients with non staphylococcus aureus gram positive coccal bacteremia
Circulation, 2009Co-Authors: Malini Madhavan, Walter R Wilson, James M Steckelberg, Muhammad R Sohail, Paul A Friedman, David L Hayes, Larry M BaddourAbstract:Introduction: Infection is a serious complication of cardiac implantable electronic Device (CIED) placement and requires Device removal for attempted cure. The Infection rate of and risk factors associated with cardiovascular implantable electronic Device Infection (CIEDI) in patients with gram-positive coccal (GPC) bacteremia excluding that due to Staphylococcus aureus have not been well studied. Methods: We retrospectively identified 74 consecutive patients with a permanent pacemaker or implantable cardioverter-defibrillator and non- S. aureus GPC bacteremia between 2001 and 2007. CIEDI was defined as presence of signs of Infection at a generator site, lead vegetations on echocardiography or microbiological growth from Device cultures. Results: CIEDI was present in 22 (30%) patients with bacteremia. The majority (n=18, 81%) of CIEDI occurred greater than 3 months after Device implantation or manipulation. Risk factors associated with CIEDI are summarized in the table. The number of leads was associated with CIEDI (p=0.03). The rate of CIEDI in patients with coagulase-negative staphylococcal (CoNS) bacteremia was almost two-fold that of non-CoNS bacteremia (36% vs 20%, p=0.13). Community-acquired CoNS bacteremia was associated with a higher rate of CIEDI compared to health care-associated and nosocomial bacteremias combined (67% vs 25%, p=0.005). Among 44 patients without identifiable CIEDI who did not undergo Device removal, 5 experienced relapse of bacteremia within 12 weeks of completing antibiotic therapy. CoNS accounted for all relapses (relapse rate =23%). Conclusion: CIEDI occurred in 30% of patients with non- S. aureus GPC bacteremia. A higher number of implanted leads was associated with a greater risk of CIEDI. Although the rate of CIEDI due CoNS bacteremia was not statistically significantly higher than that due to non-CoNS bacteremia, the almost 2-fold difference is likely clinically relevant and warrants further study.
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permanent pacemaker and implantable cardioverter defibrillator Infection a population based study
JAMA Internal Medicine, 2007Co-Authors: Daniel Z Uslan, Walter R Wilson, James M Steckelberg, Muhammad R Sohail, Paul A Friedman, David L Hayes, Jennifer L St Sauver, Sarah M Stoner, Larry M BaddourAbstract:Background The incidence of cardiac Device Infection is not well understood. Bloodstream Infection (BSI) in patients with permanent pacemakers or implantable cardioverter-defibrillators (hereafter, defibrillators) may reflect Device Infection. Methods Retrospective, population-based cohort study of all adult patients with cardiac Devices who resided in Olmsted County, Minnesota, from 1975 to 2004. The medical linkage-system of the Rochester Epidemiology Project and standardized criteria were used to identify all cases of BSI and Device Infection. The incidence of Device Infection was calculated with person-years of follow-up after Device implantation. Results A total of 1524 patients with cardiac Devices were included in the cohort. Total person-time of follow-up was 7578 years. The incidence of definite Device Infection was 1.9 per 1000 Device-years (95% confidence interval [CI], 1.1-3.1). The incidence of pocket Infection without BSI was 1.37 per 1000 Device-years (95% CI, 0.62-3.05), and pocket Infection with BSI or Device-related endocarditis 1.14 per 1000 Device years (95% CI, 0.47-2.74). The cumulative probability of Device Infection was higher among patients with defibrillators compared with those with pacemakers, P Staphylococcus aureus BSI had definite or possible cardiac Device Infection vs 3 (12.0%) of 25 cases of bloodstream Infection due to gram-negative bacilli ( P = .004). Conclusions To our knowledge, this is the first population-based study to describe the incidence of cardiac Device Infection. Device Infection was common during episodes of S aureus BSI. The rate of cardiac Device Infection was higher in patients with defibrillators than in those with pacemakers.
Larry M Baddour - One of the best experts on this subject based on the ideXlab platform.
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abstract 15979 utility of post extraction follow up blood cultures in patients with cardiovascular implantable electronic Device Infection
Circulation, 2020Co-Authors: Sarwat Khalil, Zerelda Esquer Garrigos, Douglas W Challener, Pooja Gurram, Wajeeha Tariq, Natalia Castilloalmeida, Larry M Baddour, Daniel C Desimone, Walter R Wilson, Brian D LahrAbstract:Introduction: Cardiovascular implantable electronic Devices (CIED) Infections are frequently complicated with bloodstream Infection (BSI). Complete Device removal and prolonged antimicrobial therap...
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Molecular Approach to Diagnosis of Cardiovascular Implantable Electronic Device Infection.
Clinical Infectious Diseases, 2019Co-Authors: Zerelda Esquer Garrigos, Daniel C Desimone, M. Rizwan Sohail, Paul A Friedman, Kerryl E. Greenwood-quaintance, Scott A. Cunningham, Prakhar Vijayvargiya, Madiha Fida, Jayawant N. Mandrekar, Larry M BaddourAbstract:BACKGROUND Sonicate fluid (SF), a solution derived from vortexing and sonication of explanted cardiovascular implantable electronic Devices (CIEDs), is a higher-yield specimen compared with swabs or tissues for culture-based detection of microorganisms associated with CIED Infection. Despite this, SF culture fails to identify a causative organism in ~50% of cases. We aimed to evaluate the diagnostic performance of 16S ribosomal RNA gene (rRNA) polymerase chain reaction (PCR)/sequencing of SF and compare it with that of SF culture. METHODS We identified 322 SF specimens from extracted CIEDs and reviewed clinical data for each patient. Subjects were classified as having or not having CIED Infection. Cases were subcategorized as culture negative if no significant growth was reported from SF cultures and as culture positive if an organism was detected above predefined thresholds. 16S rRNA PCR/sequencing was performed, with the organisms identified reported according to Clinical and Laboratory Standards Institute guidelines for sequence data interpretation. RESULTS A total of 278 SF samples corresponded to infected cases, of which 160 were culture positive and 118 culture negative. The remaining 44 were from noninfected cases, of which 2 were culture positive. Compared with SF culture, the sensitivity of 16S rRNA PCR/sequencing was higher (64% vs 57.5%, P = .003). 16S rRNA PCR/sequencing detected a potential pathogen in 28 of 118 culture-negative cases, identifying staphylococci in the majority (18/28). CONCLUSIONS 16S rRNA PCR/sequencing has higher sensitivity to detect bacteria in SF from extracted CIEDs than does SF culture.
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impact of abandoned leads on cardiovascular implantable electronic Device Infections a propensity matched analysis of medic multicenter electrophysiologic Device Infection cohort
JACC: Clinical Electrophysiology, 2017Co-Authors: Thomas A Boyle, Larry M Baddour, Jordan M Prutkin, Daniel Z Uslan, Arnold J Greenspon, Stephan B Danik, Jose Maria Tolosana, Jose M Miro, James E Peacock, Muhammad R SohailAbstract:Abstract Objectives This study sought to evaluate the impact of abandoned cardiovascular implantable electronic Device (CIED) leads on the presentation and management of Device-related Infections. Background Device Infection is a serious consequence of CIEDs and necessitates removal of all hardware for attempted cure. The merits of extracting or retaining presumed sterile but nonfunctioning leads is a subject of ongoing debate. Methods The MEDIC (Multicenter Electrophysiologic Device Infection Cohort) prospectively enrolled patients with CIED Infections at 10 institutions in the United States and abroad between January 1, 2009, and December 31, 2012. Within a propensity-matched cohort, relevant clinical information was compared between patients who had 1 or more abandoned leads at the time of Infection and those who had none. Results Matching produced a cohort of 264 patients, including 176 with no abandoned leads and 88 with abandoned leads. The groups were balanced with respect to Charlson comorbidity index, oldest lead age, Device type, sex, and race. At the time of admission, those with abandoned leads were less likely to demonstrate systemic signs of Infection, including leukocytosis (p = 0.023) and positive blood cultures (p = 0.005). Conversely, patients with abandoned leads were more likely to demonstrate local signs of Infections, including skin erosion (p = 0.031) and positive pocket cultures (p = 0.015). In addition, patients with abandoned leads were more likely to require laser extraction (p = 0.010). Conclusions The results of a large prospective registry of CIED Infections demonstrated that patients with abandoned leads may present with different signs, symptoms, and microbiological findings and require laser extraction more than those without abandoned leads.
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outcomes in patients with cardiovascular implantable electronic Device Infection managed with chronic antibiotic suppression
Clinical Infectious Diseases, 2017Co-Authors: Eugene M Tan, Larry M Baddour, Daniel C Desimone, Walter R Wilson, James M Steckelberg, Rizwan M Sohail, Abinash VirkAbstract:Background. Most cardiovascular implantable electronic Device (CIED) recipients are elderly, have multiple comorbid conditions, and are at increased risk of CIED Infection (CIEDI). Current guidelines recommend complete Device removal in patients with CIEDI to prevent relapse and mortality. However, comorbidities or other factors may preclude Device removal, thus prompting a nonsurgical approach that includes chronic antibiotic suppression (CAS). There are limited data on outcomes of patients receiving CAS for CIEDI. Methods. We retrospectively screened 660 CIEDI cases from 2005 to 2015 using electronic health records and a CIEDI institutional database and identified 48 patients prescribed CAS. Primary outcomes were Infection relapse and survival. Results. The median age was 78 years, and 73% (35/48) were male. The median Charlson comorbidity index was 4. Common pathogens were coagulase-negative staphylococci (21%, 10/48) and methicillin-sensitive Staphylococcus aureus (19%, 9/48). At 1 month after hospitalization, 25% (12/48) of patients had died, of whom only 1 initiated CAS; 67% (8/12) of these had staphylococcal Infections. Of the 37 patients who initiated CAS, the most common antimicrobials were trimethoprim-sulfamethoxazole, penicillin, and amoxicillin (22%, 8/37 each). Estimated median overall survival was 1.43 years (95% confidence interval, 0.27-2.14), with 18% (6/33 survivors) developing relapse within 1 year. Of the 6 patients who relapsed, 2 (33%) subsequently underwent CIED extraction. Conclusion. CAS is reasonable in select patients who are not candidates for complete Device removal for attempted cure of CIEDI. Nevertheless, 1-month mortality in our sample of CAS-eligible patients was high and reflective of high rates of comorbid conditions.
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reimplantation and repeat Infection after cardiac implantable electronic Device Infections experience from the medic multicenter electrophysiologic Device Infection cohort database
Circulation-arrhythmia and Electrophysiology, 2017Co-Authors: Thomas A Boyle, Larry M Baddour, Jordan M Prutkin, Daniel Z Uslan, Arnold J Greenspon, Stephan B Danik, Jose Maria Tolosana, Jose M Miro, James E Peacock, Muhammad R SohailAbstract:Background—Infection is a serious complication of cardiovascular-implantable electronic Device implantation and necessitates removal of all hardware for optimal treatment. Strategies for reimplanti...
Marc Faraggi - One of the best experts on this subject based on the ideXlab platform.
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whole body 18f fluorodeoxyglucose positron emission tomography imaging for the diagnosis of pacemaker or implantable cardioverter defibrillator Infection a preliminary prospective study
Clinical Microbiology and Infection, 2011Co-Authors: L Bensimhon, Thomas Lavergne, Florent Hugonnet, Jeanluc Mainardi, C Latremouille, C Maunoury, Antoine Lepillier, J Le Y Heuzey, Marc FaraggiAbstract:Abstract We studied the potential use of [ 18 F]fluorodeoxyglucose ( 18 F-FDG) whole body positron emission tomography (PET)–computed tomography for the diagnosis of Device Infection and extension of Infection. Twenty-one patients with suspected Device Infection were prospectively included and compared with 14 controls free of Infection. 18 F-FDG uptake on the box and on the leads was visually and quantitatively interpreted (using the maximal standard uptake value). The final diagnosis was obtained either from bacteriological data after Device culture ( n = 11) or by a 6-month follow-up according to modified Duke's criteria ( n = 10). Ten patients finally showed Infection on bacteriological study ( n = 8) or during follow-up ( n = 2). Sensitivity, specificity, positive predictive value and negative predictive value were, respectively, 80%, 100%, 100% and 84.6% on patient-based analysis (presence or absence of Infection). They were 100%, 100%, 100% and 100% for boxes, but only 60%, 100%, 100% and 73% for leads. Quantitative analysis could be useful for boxes but not for leads, for which the presence of a mild hot spot was the best criterion of Infection. The four false negatives on leads received antibiotics for longer than the six true positives (20 ± 7.2 vs. 3.2 ± 2.3 days, p 18 F-FDG PET imaging may be useful for the diagnosis of Device Infection, and could impact on clinical management. Interpretation of negative cases should be performed with caution if patients have received antibiotics.
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whole body 18f fluorodeoxyglucose positron emission tomography imaging for the diagnosis of pacemaker or implantable cardioverter defibrillator Infection a preliminary prospective study
Clinical Microbiology and Infection, 2011Co-Authors: L Bensimhon, Thomas Lavergne, Florent Hugonnet, C Latremouille, C Maunoury, Antoine Lepillier, J Le Y Heuzey, J L Mainardi, Marc FaraggiAbstract:We studied the potential use of [(18) F]fluorodeoxyglucose ((18) F-FDG) whole body positron emission tomography (PET)-computed tomography for the diagnosis of Device Infection and extension of Infection. Twenty-one patients with suspected Device Infection were prospectively included and compared with 14 controls free of Infection. (18) F-FDG uptake on the box and on the leads was visually and quantitatively interpreted (using the maximal standard uptake value). The final diagnosis was obtained either from bacteriological data after Device culture (n = 11) or by a 6-month follow-up according to modified Duke's criteria (n = 10). Ten patients finally showed Infection on bacteriological study (n = 8) or during follow-up (n = 2). Sensitivity, specificity, positive predictive value and negative predictive value were, respectively, 80%, 100%, 100% and 84.6% on patient-based analysis (presence or absence of Infection). They were 100%, 100%, 100% and 100% for boxes, but only 60%, 100%, 100% and 73% for leads. Quantitative analysis could be useful for boxes but not for leads, for which the presence of a mild hot spot was the best criterion of Infection. The four false negatives on leads received antibiotics for longer than the six true positives (20 ± 7.2 vs. 3.2 ± 2.3 days, p <0.01). Although the study was not designed for this purpose, management could have been modified by PET results in six of 21 patients. (18) F-FDG PET imaging may be useful for the diagnosis of Device Infection, and could impact on clinical management. Interpretation of negative cases should be performed with caution if patients have received antibiotics.
Daniel Z Uslan - One of the best experts on this subject based on the ideXlab platform.
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impact of abandoned leads on cardiovascular implantable electronic Device Infections a propensity matched analysis of medic multicenter electrophysiologic Device Infection cohort
JACC: Clinical Electrophysiology, 2017Co-Authors: Thomas A Boyle, Larry M Baddour, Jordan M Prutkin, Daniel Z Uslan, Arnold J Greenspon, Stephan B Danik, Jose Maria Tolosana, Jose M Miro, James E Peacock, Muhammad R SohailAbstract:Abstract Objectives This study sought to evaluate the impact of abandoned cardiovascular implantable electronic Device (CIED) leads on the presentation and management of Device-related Infections. Background Device Infection is a serious consequence of CIEDs and necessitates removal of all hardware for attempted cure. The merits of extracting or retaining presumed sterile but nonfunctioning leads is a subject of ongoing debate. Methods The MEDIC (Multicenter Electrophysiologic Device Infection Cohort) prospectively enrolled patients with CIED Infections at 10 institutions in the United States and abroad between January 1, 2009, and December 31, 2012. Within a propensity-matched cohort, relevant clinical information was compared between patients who had 1 or more abandoned leads at the time of Infection and those who had none. Results Matching produced a cohort of 264 patients, including 176 with no abandoned leads and 88 with abandoned leads. The groups were balanced with respect to Charlson comorbidity index, oldest lead age, Device type, sex, and race. At the time of admission, those with abandoned leads were less likely to demonstrate systemic signs of Infection, including leukocytosis (p = 0.023) and positive blood cultures (p = 0.005). Conversely, patients with abandoned leads were more likely to demonstrate local signs of Infections, including skin erosion (p = 0.031) and positive pocket cultures (p = 0.015). In addition, patients with abandoned leads were more likely to require laser extraction (p = 0.010). Conclusions The results of a large prospective registry of CIED Infections demonstrated that patients with abandoned leads may present with different signs, symptoms, and microbiological findings and require laser extraction more than those without abandoned leads.
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reimplantation and repeat Infection after cardiac implantable electronic Device Infections experience from the medic multicenter electrophysiologic Device Infection cohort database
Circulation-arrhythmia and Electrophysiology, 2017Co-Authors: Thomas A Boyle, Larry M Baddour, Jordan M Prutkin, Daniel Z Uslan, Arnold J Greenspon, Stephan B Danik, Jose Maria Tolosana, Jose M Miro, James E Peacock, Muhammad R SohailAbstract:Background—Infection is a serious complication of cardiovascular-implantable electronic Device implantation and necessitates removal of all hardware for optimal treatment. Strategies for reimplanti...
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permanent pacemaker and implantable cardioverter defibrillator Infection a population based study
JAMA Internal Medicine, 2007Co-Authors: Daniel Z Uslan, Walter R Wilson, James M Steckelberg, Muhammad R Sohail, Paul A Friedman, David L Hayes, Jennifer L St Sauver, Sarah M Stoner, Larry M BaddourAbstract:Background The incidence of cardiac Device Infection is not well understood. Bloodstream Infection (BSI) in patients with permanent pacemakers or implantable cardioverter-defibrillators (hereafter, defibrillators) may reflect Device Infection. Methods Retrospective, population-based cohort study of all adult patients with cardiac Devices who resided in Olmsted County, Minnesota, from 1975 to 2004. The medical linkage-system of the Rochester Epidemiology Project and standardized criteria were used to identify all cases of BSI and Device Infection. The incidence of Device Infection was calculated with person-years of follow-up after Device implantation. Results A total of 1524 patients with cardiac Devices were included in the cohort. Total person-time of follow-up was 7578 years. The incidence of definite Device Infection was 1.9 per 1000 Device-years (95% confidence interval [CI], 1.1-3.1). The incidence of pocket Infection without BSI was 1.37 per 1000 Device-years (95% CI, 0.62-3.05), and pocket Infection with BSI or Device-related endocarditis 1.14 per 1000 Device years (95% CI, 0.47-2.74). The cumulative probability of Device Infection was higher among patients with defibrillators compared with those with pacemakers, P Staphylococcus aureus BSI had definite or possible cardiac Device Infection vs 3 (12.0%) of 25 cases of bloodstream Infection due to gram-negative bacilli ( P = .004). Conclusions To our knowledge, this is the first population-based study to describe the incidence of cardiac Device Infection. Device Infection was common during episodes of S aureus BSI. The rate of cardiac Device Infection was higher in patients with defibrillators than in those with pacemakers.
Jose Maria Tolosana - One of the best experts on this subject based on the ideXlab platform.
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impact of abandoned leads on cardiovascular implantable electronic Device Infections a propensity matched analysis of medic multicenter electrophysiologic Device Infection cohort
JACC: Clinical Electrophysiology, 2017Co-Authors: Thomas A Boyle, Larry M Baddour, Jordan M Prutkin, Daniel Z Uslan, Arnold J Greenspon, Stephan B Danik, Jose Maria Tolosana, Jose M Miro, James E Peacock, Muhammad R SohailAbstract:Abstract Objectives This study sought to evaluate the impact of abandoned cardiovascular implantable electronic Device (CIED) leads on the presentation and management of Device-related Infections. Background Device Infection is a serious consequence of CIEDs and necessitates removal of all hardware for attempted cure. The merits of extracting or retaining presumed sterile but nonfunctioning leads is a subject of ongoing debate. Methods The MEDIC (Multicenter Electrophysiologic Device Infection Cohort) prospectively enrolled patients with CIED Infections at 10 institutions in the United States and abroad between January 1, 2009, and December 31, 2012. Within a propensity-matched cohort, relevant clinical information was compared between patients who had 1 or more abandoned leads at the time of Infection and those who had none. Results Matching produced a cohort of 264 patients, including 176 with no abandoned leads and 88 with abandoned leads. The groups were balanced with respect to Charlson comorbidity index, oldest lead age, Device type, sex, and race. At the time of admission, those with abandoned leads were less likely to demonstrate systemic signs of Infection, including leukocytosis (p = 0.023) and positive blood cultures (p = 0.005). Conversely, patients with abandoned leads were more likely to demonstrate local signs of Infections, including skin erosion (p = 0.031) and positive pocket cultures (p = 0.015). In addition, patients with abandoned leads were more likely to require laser extraction (p = 0.010). Conclusions The results of a large prospective registry of CIED Infections demonstrated that patients with abandoned leads may present with different signs, symptoms, and microbiological findings and require laser extraction more than those without abandoned leads.
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reimplantation and repeat Infection after cardiac implantable electronic Device Infections experience from the medic multicenter electrophysiologic Device Infection cohort database
Circulation-arrhythmia and Electrophysiology, 2017Co-Authors: Thomas A Boyle, Larry M Baddour, Jordan M Prutkin, Daniel Z Uslan, Arnold J Greenspon, Stephan B Danik, Jose Maria Tolosana, Jose M Miro, James E Peacock, Muhammad R SohailAbstract:Background—Infection is a serious complication of cardiovascular-implantable electronic Device implantation and necessitates removal of all hardware for optimal treatment. Strategies for reimplanti...
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diagnostic accuracy of 18f fdg pet ct in infective endocarditis and implantable cardiac electronic Device Infection a cross sectional study
The Journal of Nuclear Medicine, 2016Co-Authors: Ulises Granados, Jose Maria Tolosana, David Fuster, Juan M Pericas, Jaime Llopis, Salvador Ninot, Eduard Quintana, Manel Almela, Carlos Pare, Carlos FalcesAbstract:Early diagnosis of infective endocarditis (IE) is based on the yielding of blood cultures and echocardiographic findings. However, they have limitations and sometimes the diagnosis is inconclusive, particularly in patients with prosthetic valves (PVs) and implantable cardiac electronic Devices (ICEDs). The primary aim of this study was to evaluate the diagnostic accuracy of 18F-FDG PET/CT in patients with suspected IE and ICED Infection. Methods: A prospective study with 80 consecutive patients with suspected IE and ICED Infection (65 men and 15 women with a mean age of 68 ± 13 y) between June 2013 and May 2015 was performed in our hospital. The inclusion criteria were clinically suspected IE and ICED Infection at the following locations: native valve (NV) (n = 21), PV (n = 29), or ICED (n = 30) (automatic implantable defibrillator [n = 11] or pacemaker [n = 19]). Whole-body 18F-FDG PET/CT with a myocardial uptake suppression protocol with unfractionated heparin was performed in all patients. The final diagnosis of Infection was established by the IE Study Group according to the clinical, echocardiographic, and microbiologic findings. Results: A final diagnosis of Infection was confirmed in 31 patients: NV (n = 6), PV (n = 12), and ICED (n = 13). Sensitivity, specificity, positive predictive value, and negative predictive value for 18F-FDG PET/CT were 82%, 96%, 94%, and 87%, respectively. 18F-FDG PET/CT was false-negative in all cases with infected NV. 18F-FDG PET/CT was able to reclassify 63 of 70 (90%) patients initially classified as possible IE by modified Duke criteria. In 18 of 70 cases, 18F-FDG PET/CT changed possible to definite IE (26%) and in 45 of 70 cases changed possible to rejected IE (64%). Additionally, 18F-FDG PET/CT identified 8 cases of septic embolism and 3 of colorectal cancer in patients with a final diagnosis of IE. Conclusion:18F-FDG PET/CT proved to be a useful diagnostic tool in suspected IE and ICED Infection and should be included in the diagnostic algorithm for early diagnosis. 18F-FDG PET/CT is not useful in the diagnosis of IE in NV but should be also considered in the initial assessment of this complex scenario to rule out extracardiac complications and possible neoplasms.