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Heine N, Doll-Nikutta K, Stein F, Jakobi J, Ingendoh-Tsakmakidis A, Rehbock C, Winkel A, Barcikowski S, Stiesch M. Anti-biofilm properties of laser-synthesized, ultrapure silver-gold-alloy nanoparticles against Staphylococcus aureus. Sci Rep 2024; 14:3405. [PMID: 38336925 PMCID: PMC10858226 DOI: 10.1038/s41598-024-53782-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 02/05/2024] [Indexed: 02/12/2024] Open
Abstract
Staphylococcus aureus biofilm-associated infections are a common complication in modern medicine. Due to inherent resilience of biofilms to antibiotics and the rising number of antibiotic-resistant bacterial strains, new treatment options are required. For this purpose, ultrapure, spherical silver-gold-alloy nanoparticles with homogenous elemental distribution were synthesized by laser ablation in liquids and analyzed for their antibacterial activity on different stages of S. aureus biofilm formation as well as for different viability parameters. First, the effect of nanoparticles against planktonic bacteria was tested with metabolic activity measurements. Next, nanoparticles were incubated with differently matured S. aureus biofilms, which were then analyzed by metabolic activity measurements and three dimensional live/dead fluorescent staining to determine biofilm volume and membrane integrity. It could be shown that AgAu NPs exhibit antibacterial properties against planktonic bacteria but also against early-stage and even mature biofilms, with a complete diffusion through the biofilm matrix. Furthermore, AgAu NPs primarily targeted metabolic activity, to a smaller extend membrane integrity, but not the biofilm volume. Additional molecular analyses using qRT-PCR confirmed the influence on different metabolic pathways, like glycolysis, stress response and biofilm formation. As this shows clear similarities to the mechanism of pure silver ions, the results strengthen silver ions to be the major antibacterial agent of the synthesized nanoparticles. In summary, the results of this study provide initial evidence of promising anti-biofilm characteristics of silver-gold-alloy nanoparticles and support the importance of further translation-oriented analyses in the future.
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Affiliation(s)
- Nils Heine
- Department of Prosthetic Dentistry and Biomedical Materials Science, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
- Lower Saxony Centre of Biomedical Engineering, Implant Research and Development, Stadtfelddamm 34, 30625, Hannover, Germany.
| | - Katharina Doll-Nikutta
- Department of Prosthetic Dentistry and Biomedical Materials Science, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
- Lower Saxony Centre of Biomedical Engineering, Implant Research and Development, Stadtfelddamm 34, 30625, Hannover, Germany
| | - Frederic Stein
- Technical Chemistry I, University of Duisburg Essen, Universitaetsstr. 7, 45141, Essen, Germany
| | - Jurij Jakobi
- Technical Chemistry I, University of Duisburg Essen, Universitaetsstr. 7, 45141, Essen, Germany
| | - Alexandra Ingendoh-Tsakmakidis
- Department of Prosthetic Dentistry and Biomedical Materials Science, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
- Lower Saxony Centre of Biomedical Engineering, Implant Research and Development, Stadtfelddamm 34, 30625, Hannover, Germany
| | - Christoph Rehbock
- Technical Chemistry I, University of Duisburg Essen, Universitaetsstr. 7, 45141, Essen, Germany
| | - Andreas Winkel
- Department of Prosthetic Dentistry and Biomedical Materials Science, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
- Lower Saxony Centre of Biomedical Engineering, Implant Research and Development, Stadtfelddamm 34, 30625, Hannover, Germany
| | - Stephan Barcikowski
- Technical Chemistry I, University of Duisburg Essen, Universitaetsstr. 7, 45141, Essen, Germany
| | - Meike Stiesch
- Department of Prosthetic Dentistry and Biomedical Materials Science, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
- Lower Saxony Centre of Biomedical Engineering, Implant Research and Development, Stadtfelddamm 34, 30625, Hannover, Germany.
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Karaca B, Esin FK, Özdemir E, Tiryaki MM, Özdemir S, Kırış T. The Systemic Immune-Inflammation Index and Predicting Cardiac Implantable Electronic Device Infections. Angiology 2024; 75:15-21. [PMID: 36373263 DOI: 10.1177/00033197221139715] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023]
Abstract
This study aimed to evaluate the utility of the systemic immune-inflammation index (SII) in predicting the development of Cardiac Implantable Electronic Device (CIED) infections. A retrospective analysis was performed using the medical records of 2185 patients who underwent CIED (including de novo, revision, or upgrade) implantation at our institution from January 2012 to December 2019. We recorded CIED infections and risk factors according to the patient, device, and procedural characteristics during the median 28.7 months (6.2-56.8) follow-up. CIED infections were identified in 52 patients. Diabetes, chronic renal disease, SII before implantation, new cardiac resynchronization therapy (CRT) implantation, CRT-battery replacement, revision or upgrade, and the number of previous procedures were independent predictors of CIED infections. The area under the curve (AUC) of SII to predict CIED infection was .733 (95% CI: .654-.811). A raised SII may be a useful predictor of CIED infection.
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Affiliation(s)
- Banu Karaca
- Department of Infectious Diseases, Atatürk Training and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey
| | - Fatma Kayaaltı Esin
- Department of Cardiology, Atatürk Training and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey
| | - Emre Özdemir
- Department of Cardiology, Atatürk Training and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey
| | - Muhammet Mücahit Tiryaki
- Department of Cardiology, Atatürk Training and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey
| | - Selin Özdemir
- Department of Infectious Diseases, Atatürk Training and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey
| | - Tuncay Kırış
- Department of Cardiology, Atatürk Training and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey
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3
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Perucki WH, Makkapati S, Laslett DB, Cooper JM. Device infection mimicry: Physical examination characteristics and procedural technique for pacemaker-associated skin cancer. HeartRhythm Case Rep 2023; 9:698-700. [PMID: 38047204 PMCID: PMC10691937 DOI: 10.1016/j.hrcr.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Affiliation(s)
- William H. Perucki
- Division of Cardiology, Section of Electrophysiology, Temple Heart & Vascular Institute, Temple University Hospital, Philadelphia, Pennsylvania
| | - Shreya Makkapati
- Department of Medicine, Temple Heart & Vascular Institute, Temple University Hospital, Philadelphia, Pennsylvania
| | - David B. Laslett
- Division of Cardiology, Section of Electrophysiology, Temple Heart & Vascular Institute, Temple University Hospital, Philadelphia, Pennsylvania
| | - Joshua M. Cooper
- Division of Cardiology, Section of Electrophysiology, Temple Heart & Vascular Institute, Temple University Hospital, Philadelphia, Pennsylvania
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Sultan A, Scheurlen C, Wörmann J, van den Bruck JH, Filipovic K, Erlhöfer S, Dittrich S, Schipper JH, Lüker J, Sinning JM, Nguyen DQ, Fischer S, Steven D, Winter S. First long-term outcome data for the MicraVR™ transcatheter pacing system: data from the largest prospective German cohort. Clin Res Cardiol 2023:10.1007/s00392-023-02286-1. [PMID: 37606854 DOI: 10.1007/s00392-023-02286-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/10/2023] [Indexed: 08/23/2023]
Abstract
AIMS The MicraVR™ transcatheter pacing system (TPS) has been implemented into clinical routine for several years. The primary recipients are patients in need for VVI pacing due to bradycardia in the setting of atrial fibrillation (AF). Implantation safety and acute success have been proven in controlled studies and registries. So far only few long-term real-life data on TPS exist. We report indication, procedure and outcome data from two high-volume implanting German centers. METHODS Between 2016 and 2019, 188 (of 303) patients were included. During follow-up (FU), TPS interrogation was performed after 4 weeks and thereafter every 6 months. RESULTS Indication for TPS implantation in 159/188 (85%) patients was permanent or intermittent AV block III° in the setting of atrial fibrillation. The mean procedure duration was 50 min [35.0-70.0]. The average acute values after system release were: thresholds: 0.5V [0.38-0.74]/0.24ms; R-wave sensing: 10.0mV [8.1-13.5]; impedance: 650 Ohm [550-783]; RV-pacing demand: 16.9% [0.9-75.9]; and battery status: 3.15 V [3.12-3.16]. During FU of 723.4 ± 597.9 days, neither pacemaker failure nor infections were reported. Long-term FU revealed: thresholds: 0.5V [0.38-0.63]/0.24 ms; sensing: 12.3mV [8.9-17.2]; impedance: 570 Ohm [488-633]; RV-pacing demand: 87.1% [29.5-98.6]; and battery status 3.02 V [3.0-3.1]. Forty-three patients died from not-device-related causes. CONCLUSION This to date largest German long-term dataset for MicraVR™ TPS implantation revealed stable device parameter. Foremost, battery longevity seems to fulfill predicted values despite a significant increase in RV-pacing demand over time and even in patients with consecutive AV-node ablation. Of note, no infections or system failure were observed.
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Affiliation(s)
- Arian Sultan
- Department of Electrophysiology, Heart Center, University of Cologne, Cologne, Germany, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Cornelia Scheurlen
- Department of Electrophysiology, Heart Center, University of Cologne, Cologne, Germany, Kerpener Str. 62, 50937, Cologne, Germany
| | - Jonas Wörmann
- Department of Electrophysiology, Heart Center, University of Cologne, Cologne, Germany, Kerpener Str. 62, 50937, Cologne, Germany
| | - Jan-Hendrik van den Bruck
- Department of Electrophysiology, Heart Center, University of Cologne, Cologne, Germany, Kerpener Str. 62, 50937, Cologne, Germany
| | - Karlo Filipovic
- Department of Electrophysiology, Heart Center, University of Cologne, Cologne, Germany, Kerpener Str. 62, 50937, Cologne, Germany
| | - Susanne Erlhöfer
- Department of Electrophysiology, Heart Center, University of Cologne, Cologne, Germany, Kerpener Str. 62, 50937, Cologne, Germany
| | - Sebastian Dittrich
- Department of Electrophysiology, Heart Center, University of Cologne, Cologne, Germany, Kerpener Str. 62, 50937, Cologne, Germany
| | - Jan-Hendrik Schipper
- Department of Electrophysiology, Heart Center, University of Cologne, Cologne, Germany, Kerpener Str. 62, 50937, Cologne, Germany
| | - Jakob Lüker
- Department of Electrophysiology, Heart Center, University of Cologne, Cologne, Germany, Kerpener Str. 62, 50937, Cologne, Germany
| | | | | | | | - Daniel Steven
- Department of Electrophysiology, Heart Center, University of Cologne, Cologne, Germany, Kerpener Str. 62, 50937, Cologne, Germany
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Arcinas LA, Sheldon RS. Complications related to pacemakers and other cardiac implantable electronic devices: essentials for internists and emergency physicians. Intern Emerg Med 2023; 18:851-862. [PMID: 36892799 DOI: 10.1007/s11739-023-03227-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 02/11/2023] [Indexed: 03/10/2023]
Abstract
With the aging population, improving technology, and expanding indications for diagnosing and treating arrhythmias and heart failure, many patients are receiving cardiac implantable electronic devices (CIEDs) such as pacemakers and implantable cardioverter defibrillators. Consequently, patients with CIEDs are frequently encountered in the emergency department and in the wards. It is imperative that emergency physicians and internists have a strong foundation on CIEDs and their potential complications. This review aims to help physicians develop a framework in approaching CIEDs and to recognize and manage clinical scenarios that may arise from CIED complications.
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Affiliation(s)
- Liane A Arcinas
- Section of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
| | - Robert S Sheldon
- Section of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
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Barbosa MC, Cirillo W, Piza F, Figueiredo MJO, Silvestre OM, Fernandes-Silva MM, Schreiber R, Oliveira MFRA, Oliveira PPM, Silveira-Filho LM, Petrucci O, Coelho-Filho OR, Matos-Souza JR, Sposito AC, Nadruz W. Determinants and prognostic value of in-hospital infection in patients waiting for permanent pacemaker implantation. Int J Cardiol 2023; 370:204-208. [PMID: 36288783 DOI: 10.1016/j.ijcard.2022.10.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 09/08/2022] [Accepted: 10/19/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND In-hospital delays in permanent cardiac pacemaker (PPM) implantation are common and may result in in-hospital infection among patients waiting for PPM implantation (pre-PPM-HI). This study investigated the predictors and prognostic impact of these events. METHODS We retrospectively evaluated 905 consecutive patients (68.2 ± 16.0 years; 54% males) who underwent PPM implantation. Clinical characteristics, pre-PPM-HI and 30-day mortality were recorded and a risk score for pre-PPM-HI was generated using multivariable logistic regression coefficients. RESULTS Eigthy-nine patients (10% of the sample) developed pre-PPM-HI. Multivariable logistic regression analysis identified urinary catheter use, complete atrioventricular block, implantation of temporary pacemaker and diabetes mellitus as independent predictors of pre-PPM-HI. The generated score (range 0-10.1) played a better role in predicting pre-PPM-HI than individual factors, yielding an area under the curve [95%CI] of 0.754 [0.705-0.803]. Patients with score ≥ 7.5 had 18-fold greater risk of developing pre-PPM-HI than those with score < 2.5. Furthermore, multivariable Cox-regression analysis showed that patients who developed pre-PPM-HI had greater 30-day mortality after PPM implantation (hazard ratio [95%CI] = 2.90 [1.18-7.16], p = 0.021) compared with their counterparts. CONCLUSIONS This study reveals that pre-PPM-HI is an independent predictor of early mortality after PPM implantation. In addition, a clinical score developed from simple clinical variables accurately identified patients at high risk of pre-PPM-HI. In scenarios where delays in PPM implantation are unavoidable, such as reference hospitals with high demand, the use of this tool can potentially help in the hierarchy of patients and in the reduction of this adverse event.
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Affiliation(s)
- Matheus C Barbosa
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, São Paulo, Brazil
| | - Willian Cirillo
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, São Paulo, Brazil
| | - Fernando Piza
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, São Paulo, Brazil
| | - Marcio J O Figueiredo
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, São Paulo, Brazil
| | | | | | - Roberto Schreiber
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, São Paulo, Brazil
| | - Matheus F R A Oliveira
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, São Paulo, Brazil
| | - Pedro P M Oliveira
- Department of Surgery, School of Medical Sciences, State University of Campinas, São Paulo, Brazil
| | | | - Orlando Petrucci
- Department of Surgery, School of Medical Sciences, State University of Campinas, São Paulo, Brazil
| | - Otavio R Coelho-Filho
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, São Paulo, Brazil
| | - José R Matos-Souza
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, São Paulo, Brazil
| | - Andrei C Sposito
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, São Paulo, Brazil
| | - Wilson Nadruz
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, São Paulo, Brazil.
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7
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Hagedorn JM, Bendel MA, Hoelzer BC, Aiyer R, Caraway D. Preoperative hemoglobin A1c and perioperative blood glucose in patients with diabetes mellitus undergoing spinal cord stimulation surgery: A literature review of surgical site infection risk. Pain Pract 2023; 23:83-93. [PMID: 35748888 DOI: 10.1111/papr.13145] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/03/2022] [Accepted: 06/08/2022] [Indexed: 01/11/2023]
Abstract
AIMS The aim of our study was to review the surgical literature regarding the relationship between hemoglobin A1c (HbA1c), diagnosis of diabetes mellitus (DM), and risk of postoperative surgical site infection (SSI). METHODS A librarian-assisted literature search was performed with two goals: (1) identify surgical publications related to SSI and HbA1c values, and (2) identify publications reporting infection risk with DM in spinal cord stimulation (SCS), intrathecal drug delivery systems (IDDS), and cardiovascular implantable electronic device (CIED) implantation surgeries. Published guidelines on perioperative management of DM are reviewed. RESULTS We identified 30 studies reporting SSI and HbA1c values. The literature review indicated that for many surgical procedures, elevated HbA1c is not correlated to rate of SSI. We identified 16 studies reporting infection rates within DM cohorts following SCS, IDDS, and CIED implantation surgeries. The data reviewed did not indicate DM as an independent risk factor for SSI. CONCLUSION Preoperative HbA1c levels in patients with a history of DM is not a singularly sufficient tool to estimate risk of perioperative infection in SCS implantation surgery. Published guidelines on perioperative management of DM do not suggest a specific HbA1c above which surgery should be delayed; intentional perioperative glycemic control is recommended.
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Affiliation(s)
| | - Markus A Bendel
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Rohit Aiyer
- Richmond Interventional Pain Management, Zucker Hillside School of Medicine at Hofstra/Northwell, Staten Island, New York, USA
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8
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Paz Rios LH, Minga I, Gaznabi S, Erwin J, Tafur A, Metzl MD. The impact of an electronic medical alert system for patients with cardiac implantable electronic devices and bacteremia. J Interv Card Electrophysiol 2022; 66:525-529. [PMID: 36462065 DOI: 10.1007/s10840-022-01423-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/09/2022] [Indexed: 12/05/2022]
Affiliation(s)
- Luis H Paz Rios
- Corrigan Minehan Heart Center, Department of Medicine, Massachusetts General Hospital, Boston, USA
| | - Iva Minga
- Cardiovascular Division, Department of Medicine, NorthShore University Health System, 2650 Ridge Avenue, Evanston, IL, 60201, USA.
| | - Safwan Gaznabi
- Cardiovascular Division, Department of Medicine, NorthShore University Health System, 2650 Ridge Avenue, Evanston, IL, 60201, USA
| | - John Erwin
- Cardiovascular Division, Department of Medicine, NorthShore University Health System, 2650 Ridge Avenue, Evanston, IL, 60201, USA
| | - Alfonso Tafur
- Cardiovascular Division, Department of Medicine, NorthShore University Health System, 2650 Ridge Avenue, Evanston, IL, 60201, USA
| | - Mark D Metzl
- Cardiovascular Division, Department of Medicine, NorthShore University Health System, 2650 Ridge Avenue, Evanston, IL, 60201, USA
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9
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Ngiam JN, Liong TS, Sim MY, Chew NWS, Sia CH, Chan SP, Lim TW, Yeo TC, Tambyah PA, Loh PH, Poh KK, Kong WKF. Risk Factors for Mortality in Cardiac Implantable Electronic Device (CIED) Infections: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11113063. [PMID: 35683451 PMCID: PMC9181812 DOI: 10.3390/jcm11113063] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/22/2022] [Accepted: 05/25/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Infections following cardiac implantable electronic device (CIED) implantation can require surgical device removal and often results in significant cost, morbidity, and potentially mortality. We aimed to systemically review the literature and identify risk factors associated with mortality following CIED infection. Methods: Electronic searches (up to June 2021) were performed on PubMed and Scopus. Twelve studies (10 retrospective, 2 prospective cohort studies) were included for analysis. Meta-analysis was conducted with the restricted maximum likelihood method, with mortality as the outcome. The overall mortality was 13.7% (438/1398) following CIED infection. Results: On meta-analysis, the male sex (OR 0.77, 95%CI 0.57–1.01, I2 = 2.2%) appeared to have lower odds for mortality, while diabetes mellitus appeared to be associated with higher mortality (OR 1.47, 95%CI 0.67–3.26, I2 = 81.4%), although these trends did not reach statistical significance. Staphylococcus aureus as the causative organism (OR 2.71, 95%CI 1.76–4.19, I2 = 0.0%), presence of heart failure (OR 1.92, 95%CI 1.42–4.19, I2 = 0.0%) and embolic phenomena (OR 4.00, 95%CI 1.67–9.56, I2 = 69.8%) were associated with higher mortality. Surgical removal of CIED was associated with lower mortality compared with conservative management with antibiotics alone (OR 0.22, 95%CI 0.09–0.50, I2 = 62.8%). Conclusion: We identified important risk factors associated with mortality in CIED infections, including Staphyloccocus aureus as the causative organism, and the presence of complications, such as heart failure and embolic phenomena. Surgery, where possible, was associated with better outcomes.
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Affiliation(s)
- Jinghao Nicholas Ngiam
- Division of Infectious Diseases, Department of Medicine, National University Health System, Singapore 119228, Singapore; (J.N.N.); (P.A.T.)
| | - Tze Sian Liong
- Department of Medicine, National University Health System, Singapore 119228, Singapore; (T.S.L.); (M.Y.S.)
| | - Meng Ying Sim
- Department of Medicine, National University Health System, Singapore 119228, Singapore; (T.S.L.); (M.Y.S.)
| | - Nicholas W. S. Chew
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore 119074, Singapore; (N.W.S.C.); (C.-H.S.); (T.W.L.); (T.-C.Y.); (P.H.L.); (K.K.P.)
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore 119074, Singapore; (N.W.S.C.); (C.-H.S.); (T.W.L.); (T.-C.Y.); (P.H.L.); (K.K.P.)
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore;
| | - Siew Pang Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore;
- Cardiovascular Research Institute, National University Health System, Singapore 119074, Singapore
| | - Toon Wei Lim
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore 119074, Singapore; (N.W.S.C.); (C.-H.S.); (T.W.L.); (T.-C.Y.); (P.H.L.); (K.K.P.)
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore;
| | - Tiong-Cheng Yeo
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore 119074, Singapore; (N.W.S.C.); (C.-H.S.); (T.W.L.); (T.-C.Y.); (P.H.L.); (K.K.P.)
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore;
| | - Paul Anantharajah Tambyah
- Division of Infectious Diseases, Department of Medicine, National University Health System, Singapore 119228, Singapore; (J.N.N.); (P.A.T.)
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore;
- Infectious Diseases Translational Research Programme, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Poay Huan Loh
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore 119074, Singapore; (N.W.S.C.); (C.-H.S.); (T.W.L.); (T.-C.Y.); (P.H.L.); (K.K.P.)
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore;
| | - Kian Keong Poh
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore 119074, Singapore; (N.W.S.C.); (C.-H.S.); (T.W.L.); (T.-C.Y.); (P.H.L.); (K.K.P.)
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore;
| | - William K. F. Kong
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore 119074, Singapore; (N.W.S.C.); (C.-H.S.); (T.W.L.); (T.-C.Y.); (P.H.L.); (K.K.P.)
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore;
- Correspondence: ; Tel.: +65-67722476; Fax: +65-68722998
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Vasudeva R, Ters P, Muraga R, Sweet D. Cardiovascular Implantable Electronic Device Removal in a Patient with Negative Blood Cultures. Kans J Med 2022; 15:144-145. [PMID: 35646250 PMCID: PMC9110046 DOI: 10.17161/kjm.vol15.15998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/24/2022] [Indexed: 11/21/2022] Open
Affiliation(s)
- Rhythm Vasudeva
- Medicine-Pediatrics Residency Program, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Patrick Ters
- Department of Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS
- Cardiovascular Consultants of Kansas, P.A., Wichita, KS
| | - Richard Muraga
- Department of Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Donna Sweet
- Department of Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS
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11
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Modi RM, Liu CL, Isaza N, Raber I, Calvachi P, Zimetbaum P, Bellows BK, Kramer DB, Kazi DS. Cost-Effectiveness of Antibiotic-Eluting Envelope for Prevention of Cardiac Implantable Electronic Device Infections in Heart Failure. Circ Cardiovasc Qual Outcomes 2022; 15:e008443. [PMID: 35105176 DOI: 10.1161/circoutcomes.121.008443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Use of an antibiotic-eluting envelope (AEE) during cardiac implantable electronic device procedures reduces infection risk but increases procedural costs. We aim to estimate the cost-effectiveness of AEE use during cardiac implantable electronic device procedures among patients with heart failure. METHODS A state-transition cohort model of heart failure patients undergoing cardiac implantable electronic device implantation or generator replacement was developed with input parameters estimated from randomized trials, registries, surveys, and claims data. Effectiveness was estimated from the World-Wide Randomized Antibiotic Envelope Infection Prevention Trial. AEE was assumed to cost $953 per unit. The model projected mortality, quality-adjusted life-years, costs, and the incremental cost-effectiveness ratio of AEE use compared with usual care from a US healthcare sector perspective over a lifetime horizon. We assumed a cost-effectiveness threshold of $100 000 per quality-adjusted life-year gained. RESULTS Compared with usual care, AEE use in initial implantations produced an incremental cost-effectiveness ratio of $112 000 per quality-adjusted life-year gained (39% probability of being cost-effective). In generator replacement procedures, AEE use produced an incremental cost-effectiveness ratio of $54 000 per quality-adjusted life-year gained (84% probability of being cost-effective). Results were sensitive to the underlying rate of infection, cost of the AEE, and durability of AEE effectiveness. CONCLUSIONS Universal AEE use for cardiac implantable electronic device procedures in patients with heart failure with reduced ejection fraction is unlikely to be cost-effective, reinforcing the need for individualized risk assessment to guide uptake of the AEE in clinical practice. Selective use in patients at increased risk of infection, such as those undergoing generator replacement procedures, is more likely to meet health system value benchmarks.
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Affiliation(s)
- Ronuk M Modi
- Division of Cardiology (R.M.M., I.R., P.Z., D.B.L., D.S.K.), Beth Israel Deaconess Medical Center, Boston, MA.,Harvard Medical School, Boston, MA (R.M.M., N.I., I.R., P.C., P.Z., D.B.L., D.S.K.)
| | - Chia-Liang Liu
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Boston, MA (C.-L.L., P.Z., D.B.L., D.S.K.).,Harvard T.H. Chan School of Public Health, Boston, MA (C.-L.L.)
| | - Nicolas Isaza
- Department of Internal Medicine (N.I.), Beth Israel Deaconess Medical Center, Boston, MA.,Harvard Medical School, Boston, MA (R.M.M., N.I., I.R., P.C., P.Z., D.B.L., D.S.K.)
| | - Inbar Raber
- Division of Cardiology (R.M.M., I.R., P.Z., D.B.L., D.S.K.), Beth Israel Deaconess Medical Center, Boston, MA.,Harvard Medical School, Boston, MA (R.M.M., N.I., I.R., P.C., P.Z., D.B.L., D.S.K.)
| | - Paola Calvachi
- Harvard Medical School, Boston, MA (R.M.M., N.I., I.R., P.C., P.Z., D.B.L., D.S.K.)
| | - Peter Zimetbaum
- Division of Cardiology (R.M.M., I.R., P.Z., D.B.L., D.S.K.), Beth Israel Deaconess Medical Center, Boston, MA.,Harvard Medical School, Boston, MA (R.M.M., N.I., I.R., P.C., P.Z., D.B.L., D.S.K.).,Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Boston, MA (C.-L.L., P.Z., D.B.L., D.S.K.)
| | - Brandon K Bellows
- Division of General Medicine, Columbia University Department of Medicine, New York City, NY (B.K.B.)
| | | | - Dhruv S Kazi
- Division of Cardiology (R.M.M., I.R., P.Z., D.B.L., D.S.K.), Beth Israel Deaconess Medical Center, Boston, MA.,Harvard Medical School, Boston, MA (R.M.M., N.I., I.R., P.C., P.Z., D.B.L., D.S.K.).,Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Boston, MA (C.-L.L., P.Z., D.B.L., D.S.K.)
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12
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Bacteriophage Therapy as a Treatment Option for Complex Cardiovascular Implant Infection: The German Heart Center Berlin experience. J Heart Lung Transplant 2022; 41:551-555. [DOI: 10.1016/j.healun.2022.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 01/09/2022] [Accepted: 01/12/2022] [Indexed: 12/18/2022] Open
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George MP, Esquer Garrigos Z, Vijayvargiya P, Anavekar NS, Luis SA, Wilson WR, Baddour LM, Sohail MR. Discriminative Ability and Reliability of Transesophageal Echocardiography in Characterizing Cases of Cardiac Device Lead Vegetations Versus Noninfectious Echodensities. Clin Infect Dis 2021; 72:1938-1943. [PMID: 32533828 DOI: 10.1093/cid/ciaa472] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 04/22/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Approximately one-third of cases of cardiovascular implantable electronic device (CIED) infection present as CIED lead infection. The precise transesophageal echocardiographic (TEE) definition and characterization of "vegetation" associated with CIED lead infection remain unclear. METHODS We identified a sample of 25 consecutive cases of CIED lead infection managed at our institution between January 2010 and December 2017. Cases of CIED lead infection were classified using standardized definitions. Similarly, a sample of 25 noninfected patients who underwent TEE that showed a defined lead echodensity during the study period was included as a control group. TEEs were reviewed by 2 independent echocardiologists who were blinded to all linked patient demographic, clinical, and microbiological information. Reported echocardiographic variables of the infected vs noninfected cases were compared, and the overall diagnostic performance was analyzed. RESULTS Descriptions of lead echodensities were variable and there were no significant differences in median echodensity diameter or mobility between infected vs noninfected groups. Among infected cases, blinded echocardiogram reports by either reviewer correctly made a prediction of infection in 6 of 25 (24%). Interechocardiologist agreement was 68%. Sensitivity of blinded TEEs ranged from 31.5% to 37.5%. CONCLUSIONS Infectious vs noninfectious lead echodensities could not be reliably distinguished on the basis of size, mobility, and general shape descriptors obtained from a retrospective blinded TEE examination without knowledge of clinical and microbiological parameters. Therefore, a reanalysis of criteria used to support a diagnosis of CIED lead infection may be warranted.
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Affiliation(s)
- Merit P George
- Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Zerelda Esquer Garrigos
- Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Prakhar Vijayvargiya
- Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Nandan S Anavekar
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Sushil Allen Luis
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Walter R Wilson
- Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA.,Division of Cardiac Imaging, Department of Radiology, Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Larry M Baddour
- Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA.,Division of Cardiac Imaging, Department of Radiology, Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - M Rizwan Sohail
- Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA.,Division of Cardiac Imaging, Department of Radiology, Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
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Lin AY, Saul T, Aldaas OM, Lupercio F, Ho G, Pollema T, Pretorius V, Birgersdotter-Green U. Early Versus Delayed Lead Extraction in Patients With Infected Cardiovascular Implantable Electronic Devices. JACC Clin Electrophysiol 2021; 7:755-763. [PMID: 33358664 PMCID: PMC8209117 DOI: 10.1016/j.jacep.2020.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 10/30/2020] [Accepted: 11/03/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study sought to assess the impact of early versus delayed lead extraction in patients with an infected cardiovascular implantable electronic device (CIED). BACKGROUND CIED infections are associated with poor outcomes. Prior studies have demonstrated improved survival with CIED extraction compared with antibiotic therapy alone. The impact of timing of CIED extraction has not been well characterized. METHODS All infected CIED extraction cases at our medical center from 2006 to 2019 were reviewed. Patients were divided into 2 groups based on the presence of bacteremia or isolated pocket infection. We assessed the in-hospital morbidity and 1-year mortality for early versus delayed lead extraction, using hospitalization day 7 as cutoff. RESULTS Of 233 patients who underwent CIED extraction, 127 patients had bacteremia and 106 patients had pocket infection. Delayed extraction (15.2 days) in bacteremic patients was associated with septic shock (odds ratio [OR]: 5.39; 95% confidence interval [CI]: 1.23 to 23.67; p = 0.026), acute kidney injury (OR: 5.61; 95% CI: 2.15 to 14.63; p < 0.001), respiratory failure (OR: 5.52; 95% CI: 1.25 to 24.41; p = 0.024), and decompensated heart failure (OR: 3.32; 95% CI: 1.10 to 10.05; p = 0.033). Locally infected patients with delayed extraction (10.7 days) were associated with acute kidney injury (OR: 3.45; 95% CI: 1.11 to 10.77; p = 0.033) and respiratory failure (OR: 10.29; 95% CI: 1.26 to 83.93; p = 0.030). Delayed CIED extraction in both groups was associated with increased 1-year mortality. CONCLUSIONS Delayed infected CIED extraction is associated with worse outcomes. This underscores the importance of early detection and a strategy for prompt management including lead extraction.
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Affiliation(s)
- Andrew Y Lin
- Division of Cardiology, University of California-San Diego, La Jolla, California, USA.
| | - Tatiana Saul
- Division of Cardiology, University of California-San Diego, La Jolla, California, USA
| | - Omar M Aldaas
- Division of Cardiology, University of California-San Diego, La Jolla, California, USA
| | - Florentino Lupercio
- Division of Cardiology, University of California-San Diego, La Jolla, California, USA
| | - Gordon Ho
- Division of Cardiology, University of California-San Diego, La Jolla, California, USA
| | - Travis Pollema
- Division of Cardiothoracic Surgery, University of California-San Diego, La Jolla, California, USA
| | - Victor Pretorius
- Division of Cardiothoracic Surgery, University of California-San Diego, La Jolla, California, USA
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Single-Chamber Cardiac Pacemaker Implantation in a Donkey with Complete AV Block: A Long-Term Follow-Up. Animals (Basel) 2021; 11:ani11030746. [PMID: 33803127 PMCID: PMC8000704 DOI: 10.3390/ani11030746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/02/2021] [Accepted: 03/04/2021] [Indexed: 11/17/2022] Open
Abstract
A five-month-old African jenny was presented with a history of exercise intolerance and syncopal episodes. Severe bradycardic arrhythmia due to a high-grade second-degree atrioventricular (AV) block with progression to complete AV block was diagnosed. The jenny underwent a transvenous single-chamber pacemaker implantation. The implantation procedure was performed in a lateral recumbency and the ventricular lead was inserted through the jugular vein. Positioning of the lead was guided by echocardiography. The pacemaker was programmed to VVI mode with a minimal ventricular rate of 40 pulses per minute, a pulse amplitude of 2.4 V, a pulse width of 0.5 ms and sensing amplitude of 2.5 mV. Short-term complications associated with the procedure included lead dislodgement and pacemaker pocket infection. The long-term outcome was satisfactory; the jenny showed improvement in heart function and quality of life after pacemaker implantation. The pulse generator replacement was performed twice (at nine-year intervals) and the intervention was always associated with a local inflammatory reaction around the pacing device. Cardiac examination 18 years after pacemaker implantation revealed no morphological changes in the heart; the electrode lead was still in the correct position and successful pacing and sensing of the ventricle were obtained. Regular follow-up checks are important to evaluate pacemaker function.
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Tabbah RN, Abi-Saleh B. Erosion of Cardiovascular Implantable Device: Conservative Therapy or Extraction? Cureus 2020; 12:e12032. [PMID: 33457133 PMCID: PMC7797431 DOI: 10.7759/cureus.12032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The standard of care for device infection is normally a complete removal of the implantable system, including lead extraction in local or systemic infection cases. Despite the importance of lead extraction techniques, these techniques are complex and have some major risks. Success rates were high, but they are less favorable in patients with several comorbidities. An 80-year-old male presented for device erosion. The patient is known to have several cardiac comorbidities: a transcatheter aortic valve replacement (TAVR), mitral clips for severe aortic stenosis, mitral regurgitation, dual-chamber implantable cardioverter defibrillators (ICD) for secondary prevention. Several weeks ago, he noted tenderness and redness at the site of his device pocket, and his physician, after checking his wound, suggested a possible skin irritation with no systemic infection and started antibiotics treatment. Two weeks later, he noted thinning of the skin around the device with a hematoma and ecchymosis, and slight skin erosion. Strategies for assessment of the wound and pocket cleaning were taken. The strategy was to remove the left-sided device and keep the leads since the patient lately has no elevated inflammatory labs, negative cultures, no fever, nor signs of vegetation on transesophageal echocardiography (TEE) and refused any additional examination as positron emission tomography (PET) scan, and reimplant a new system on the contralateral side. The procedure was divided into two sequences: extracting the device and after one-week implantation of a right-sided new system. In this case, chronic antibiotics were discussable to decrease the recurrence rate, but they did increase the severity of the patient's thrombocytopenia. Despite extraction being the gold standard of treatment in most cases of devices with local and systemic infection, there are some frail patients with several comorbidities where extraction is unbearable due to its major risks and complex procedure. In these specific cases with local infection and device erosion with no signs of any systemic infection, conservative therapy could be a viable option.
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Affiliation(s)
- Randa N Tabbah
- Cardiology, Centre Hospitalier Universitaire Notre Dame de Secours, Beirut, LBN
| | - Bernard Abi-Saleh
- Cardiology, American University of Beirut Medical Center, Beirut, LBN
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Nikam SP, Nettleton K, Everitt JI, Barton HA, Becker ML. Antibiotic eluting poly(ester urea) films for control of a model cardiac implantable electronic device infection. Acta Biomater 2020; 111:65-79. [PMID: 32447067 DOI: 10.1016/j.actbio.2020.04.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/05/2020] [Accepted: 04/13/2020] [Indexed: 02/07/2023]
Abstract
Cardiac implantable electronic device (CIED) infections acquired during or after surgical procedures are a major complication that are challenging to treat therapeutically, resulting in chronic and sometimes fatal infections. Localized delivery of antibiotics at the surgical site could be used to supplement traditional systemic administration as a preventative measure. Herein, we investigate a cefazolin-eluting l-valine poly(ester urea) (PEU) films as a model system for localized antibiotic delivery for CIEDs. Poly(1-VAL-8) PEU was used to fabricate a series of antibiotic-loaded films with varied loading concentrations (2%, 5%, 10% wt/wt) and thicknesses (40 µm, 80 µm, 140 µm). In vitro release measurements show thickness and loading concentration influence the amount and rate of cefazolin release. Group 10%-140 µm (load-thickness) showed 22.5% release of active pharmaceutical ingredient (API) in the first 24 h and 81.2% of cumulative percent release through day 14 and was found most effective in bacterial clearance in vitro. This group was also effective in clearing a bacterial infection in a model in vivo rat study while eliciting a limited inflammatory response. Our results suggest the feasibility of cefazolin-loaded PEU films as an effective sustained release matrix for localized delivery of antibiotics. SIGNIFICANCE STATEMENT: Implant-associated infections acquired during surgical procedures are a major complication that have proven a challenge to treat clinically, resulting in chronic and sometimes fatal infections. In this manuscript, we investigate an antibiotic-eluting L-valine poly(ester urea) (PEU) films as a model system for localized delivery of cefazolin. Significantly, we demonstrate a wide variation in temporal delivery and dosing within this family of PEUs and show that the delivery can be extended by varying the film thickness. The in vivo results show efficacy in an infected wound model and suggest antibiotic loaded PEU films function as an effective sustained release matrix for localized delivery of antibiotics across a number of clinical indications.
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18
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Kaya E, Siebermair J, Vonderlin N, Hadjamu N, Azizy O, Rassaf T, Wakili R. Impact of diabetes as a risk factor in patients undergoing subcutaneous implantable cardioverter defibrillator implantation: A single-centre study. Diab Vasc Dis Res 2020; 17:1479164120911560. [PMID: 32292066 PMCID: PMC7510351 DOI: 10.1177/1479164120911560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Patients with diabetes mellitus are known to carry an increased risk for surgical site infections and perioperative complications. The subcutaneous implantable cardioverter defibrillator is an established treatment option in patients at risk for sudden cardiac death especially with an increased risk for infection over time. METHODS AND RESULTS Forty-eight patients (mean age = 55.0 ± 21.3 years, 31.3% patients with diabetes mellitus, 75% male) who underwent consecutive subcutaneous implantable cardioverter defibrillator surgery between February 2016 and May 2019 were retrospectively analysed. Overall adverse events including relevant bleeding complications, any surgical wound problems and infections requiring reoperation or device malfunction were evaluated as primary combined safety endpoint. Patients with diabetes mellitus tended to be older with a higher body mass index compared to non-diabetes mellitus. Procedure duration and postsurgery hospital days were not different in diabetes mellitus versus non-diabetes mellitus patients. Analysis of the primary combined endpoint showed no significant difference but a trend towards higher event rates in the diabetes mellitus group (diabetes mellitus vs non-diabetes mellitus: 20% vs 12.1%, p = 0.119). CONCLUSION Diabetes mellitus is a frequent and relevant variable in patients undergoing subcutaneous implantable cardioverter defibrillator implantation represented by 31.3% in this consecutive cohort. Our results suggest that diabetes mellitus is not associated with a prolonged hospital stay or increased rate of periprocedural adverse events.
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Affiliation(s)
| | | | | | | | | | | | - Reza Wakili
- Reza Wakili, Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, University of Duisburg–Essen, Essen, Hufelandstrasse 55, 45147 Essen, Germany.
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Negative Pressure Wound Therapy Reduces Wound Breakdown and Implant Loss in Prepectoral Breast Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2667. [PMID: 32309105 PMCID: PMC7159936 DOI: 10.1097/gox.0000000000002667] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 01/06/2020] [Indexed: 12/14/2022]
Abstract
Background: Single-use negative pressure wound therapy (NPWT) has been shown to encourage wound healing. It is often used when patient factors impair wound healing, or in more complex wounds, such as in implant-based breast reconstruction. We report the findings of a prospective cohort study comparing the use of NPWT with standard dressings in prepectoral breast reconstruction. Methods: A prospective database of implant-based reconstruction from a single institution was mined to identify patients who underwent prepectoral reconstruction. Patient demographics, operative data, surgical complications, and 90-day outcomes were compared between patients who had NPWT and those who had standard dressings. Results: Prepectoral implant-based breast reconstruction was performed on 307 breasts. NPWT dressings were used in 126 cases, with standard dressings used in 181 cases. Wound breakdown occurred in 10 cases after standard dressings versus 1 where NPWT was utilized. Of the standard dressing cases, only 3 implants were salvaged, while 7 cases led to implant loss. The 1 case of wound breakdown in the NPWT cohort settled with conservative measures. The cost of a reconstructive failure was £14,902, and the use of NPWT resulted in a cost savings of £426 per patient. Conclusions: The utilization of single-use NPWT reduces the rate of wound breakdown and implant loss in prepectoral implant-based reconstruction. In addition to the significant clinical benefits, this approach is cost-saving compared with standard dressings. These data suggest that prepectoral implant reconstruction should be considered as an indication for the use of NPWT.
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Kaya E, Senges J, Hochadel M, Eckardt L, Andresen D, Ince H, Spitzer SG, Kleemann T, Maier SSK, Jung W, Stellbrink C, Rassaf T, Wakili R. Impact of diabetes on clinical outcome of patients with heart failure undergoing ICD and CRT procedures: results from the German Device Registry. ESC Heart Fail 2020; 7:984-995. [PMID: 32068978 PMCID: PMC7261544 DOI: 10.1002/ehf2.12613] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 12/06/2019] [Accepted: 12/22/2019] [Indexed: 12/01/2022] Open
Abstract
Aims Diabetes mellitus (DM) has a negative impact on prognosis in patients with heart failure (HF). The role impact of DM in HF patients with implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy (CRT) devices might differ and remains unclear. The aim of our study was to investigate the impact of DM on periprocedural complications and clinical outcome in HF patients undergoing ICD or CRT implantation. Methods and results Within the German Device Registry, data from 50 German centres were collected between January 2007 and February 2014. A retrospective analysis of n = 5329 patients undergoing ICD implantation was conducted. Patients' characteristics, procedural data, periprocedural complications, and post‐procedural clinical outcome, including a composite clinical endpoint of all‐cause mortality, stroke, and myocardial infarction (MACCE), were analysed. Subgroup analysis were performed for ICD and CRT implantations. Median follow‐up was 15.7 (12.9; 20.0) and 16.2 (12.8; 21.2) months in DM and non‐DM patients. Of 5329 patients enrolled, n = 1448 (27.2%) had a diagnosis of DM. Within the cohort, 94% of DM and 90% of non‐DM patients had a diagnosis of HF. Patients with DM were older, had higher body mass index, and higher rate of cardiovascular comorbidities compared with non‐DM patients. Unadjusted and adjusted analyses revealed similar all‐over intrahospital periprocedural complication rates in both groups (4.1% vs 3.9%). Unadjusted Kaplan–Meier survival analysis showed higher all‐cause mortality after 1 year (9.0% vs 6.3%; log‐rank P = 0.001) with higher MACCE rates (10.0% vs 7.3%; P < 0.001) in the DM group versus non‐DM patients. After multivariable adjustment for relevant covariates, the association of DM to MACCE disappeared [HR 1.11 (0.89‐1.38)]. Because chronic kidney disease (CKD) was clearly associated with increased 1 year MACCE after multivariate adjustment [odds ratio (OR) 2.11 (1.68–2.64)], a subgroup analysis was performed showing a strong trend towards more perioperative complications in DM patients with CKD [OR 2.16 (0.9–5.21)], while no effect of DM was observed in patients without CKD [OR 0.73 (0.42–1.28)]. Conclusions The overall risk of periprocedural complications and short‐term (1 year) clinical outcome in patients with DM and HF undergoing ICD or CRT defibrillator (CRT‐D) implantation was not increased. In contrast, CKD was associated with an increased risk of 1 year MACCE in HF patients undergoing ICD/CRT‐D implantation.
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Affiliation(s)
- Elif Kaya
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Jochen Senges
- Stiftung Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Ludwigshafen, Germany
| | - Matthias Hochadel
- Stiftung Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Ludwigshafen, Germany
| | - Lars Eckardt
- Department of Cardiology II - Electrophysiology, University of Münster, Münster, Germany
| | - Dietrich Andresen
- Klinik für Kardiologie, Evangelisches Krankenhaus Hubertus, Berlin, Germany
| | - Hüseyin Ince
- Department of Cardiology and Internal Medicine, Vivantes Klinikum Am Urban, Berlin, Germany.,Department of Cardiology, Heart Center Rostock, Rostock University Medical Center, Rostock, Germany
| | - Stefan G Spitzer
- Praxisklinik Herz und Gefäße Dresden and Brandenburg, Institut of Medical Technology, University of Technology Cottbus-Senftenberg, Ludwigshafen, Germany
| | - Thomas Kleemann
- Department of Cardiology, Klinikum Ludwigshafen, Villingen-Schwenningen, Germany
| | | | - Werner Jung
- Department of Cardiology, Academic Hospital Villingen, Villingen-Schwenningen, Germany
| | | | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Reza Wakili
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
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Wengrofsky P, Soleiman A, Benyaminov F, Oleszak F, Salciccioli L, McFarlane SI. Enterobacter Cloacae Device Endocarditis: Case Report, Scoping Study, and Guidelines Review. CARDIOLOGY & VASCULAR RESEARCH (WILMINGTON, DEL.) 2019; 3:10.33425/2639-8486.1050. [PMID: 31245792 PMCID: PMC6594712 DOI: 10.33425/2639-8486.1050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
While traditionally an infection of the endocardial surface of heart valves, infective endocarditis (IE), can atypically present as infection of cardiac implantable electronic devices (CIED), including permanent pacemakers (PPM) or automatic implantable cardioverter-defibrillators (AICD). CIED endocarditis, similar to valvular IE, is generally caused by Gram-positive organisms such as Staphylococcus spp., most frequently S. Auerus, but is rarely caused by gram-negative bacteria, both HACEK and non-HACEK species. We present the case of Enterobacter cloacae CIED endocarditis. We also present a scoping study of previous case reports and case series highlighting the risk factors, surgical interventions, and mortality outcomes associated with E. Cloacae endocarditis. We also discuss the current guidelines and recommendations on antibiotic therapies for non-HACEK Gram-negative endocarditis and surgical management of infected CIED extraction and replacement.
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Affiliation(s)
- Perry Wengrofsky
- Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn, N.Y., U.S.A
| | - Aron Soleiman
- Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn, N.Y., U.S.A
| | - Fuad Benyaminov
- Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn, N.Y., U.S.A
| | - Filip Oleszak
- Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn, N.Y., U.S.A
| | - Louis Salciccioli
- Division of Cardiovascular Disease, Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn, N.Y., U.S.A
| | - Samy I. McFarlane
- Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn, N.Y., U.S.A.,Correspondence: Samy I. McFarlane, Distinguished Teaching Professor and Associate Dean, Department of Medicine, Division of Endocrinology, Internal Medicine Residency Program Director, State University of New York-Downstate Medical Center, Brooklyn, New York, Tel: 718-270-3711; Fax: 718-270-6358;
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Fukata M, Arita T, Kadota H, Odashiro K, Maruyama T, Akashi K. Successful management of wound dehiscence after implantation of a subcutaneous implantable cardioverter-defibrillator without device removal. HeartRhythm Case Rep 2017; 3:415-417. [PMID: 28948145 PMCID: PMC5601323 DOI: 10.1016/j.hrcr.2017.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mitsuhiro Fukata
- Department of Hematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Takeshi Arita
- Department of Hematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Hideki Kadota
- Department of Plastic and Reconstructive Surgery, Kyushu University Hospital, Fukuoka, Japan
| | - Keita Odashiro
- Department of Hematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Toru Maruyama
- Faculty of Art and Science, Kyushu University, Fukuoka, Japan
| | - Koichi Akashi
- Department of Hematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
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