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Guidelines
Infections of IECDs

Infections of IECDs

Note

The diagnosis of infective endocarditis in patients with Implantable Electronic Cardiac Devices (IECD) can be very challenging.

In cases where IECD infections are suspected, Infectious Diseases and Cardiology consultations are strongly recommended.

Tailored management is critical and device removal including wire/lead extraction may be required. The Modified Duke Criteria do not have sufficient sensitivity for diagnosis of IECD infections.

Consults

In cases where IECD infections are suspected, Infectious Diseases and Cardiology consultations are strongly recommended.

  • Coagulase negative Staphylococcus spp.
  • Staphylococcus aureus
  • Gram negative bacilli
  • Other Gram positive cocci
  • Polymicrobial infection
  • Rarely fungi and mycobacteria
  • Inflammation at pocket site or erosion.
  • Septic pulmonary emboli from wire infection or tricuspid valve endocarditis.
  • Subacute symptoms of bloodstream infection including malaise, anorexia, fever.
  • Obtain multiple sets of blood cultures prior to initiation of antimicrobial therapy for all suspected cardiac device-related infections.
  • TEE is superior to TTE in patients with suspected device-related infective endocarditis.
  • Bacteremia with Staphylococcus aureus dramatically increases the likelihood of device-related infection.
  • Empiric therapy is similar to that of prosthetic valve infective endocarditis.
  • In cases where IECD infections are suspected, Infectious Diseases and Cardiology consultations are strongly recommended.