6th dec prevention and treatment of pacemaker infection both 2 last version126预防治疗起搏器感染及两种actfixlead 2.pptx

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6th dec prevention and treatment of pacemaker infection both 2 last version126预防治疗起搏器感染及两种actfixlead 2.pptx

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PreventionandTreatmentofInfectionsDr.GeorgiosZervopoulos

InfectionsAreIncreasinginFrequencyFasterThanImplants1ContributingFactorsforIncreaseOlderPatientsReceivingDevicesMorePatientComorbiditiesMixofCIEDsisChangingNumberofPulseGeneratorReplacementsUpgradesisIncreasingMoreResistantSaureusCoagulase(-)StaphylococcusSpecies1.GreensponAetal.JAmCollCardiol201158(10)1001-1006.

OverallInfectionRateat1Yearis3.1%

HighPowerRatesLowPowerRatesatAllTimePointsInfectionRateAcrossallProcedureTypes@1yearDataonFile–TruvenMarketscanResearch

MortalitysignificantlyincreasesfollowingCIEDInfectionsinMedicareBeneficiariesPublishedinonNov.14,201111Sohailetal.ArchivesofInternalMedicine2011171(20),1821-18284.8to7.7FoldIncreaseInAdmissionMortality1.6to2.1FoldIncreasesLongTermMortality(27-36%@1Yr)P0.001forallcomparisonsofwith/withoutinfection

ClinicalNeedStandardofCare

ClinicalNeedStandardofCareClinicalProblemsCardiacImplantableElectronicDevice(CIED)relatedinfectionsareincreasinginfrequencyareexpensivetotreat1SpecificpatientconditionsprocedurecharacteristicssignificantlyincreasetheriskofCIEDinfections(e.g.,renalinsufficiencyfailure,diabetesmellitus,multi-leaddevicepatients,replacementrevisionprocedures)2StandardtreatmentforCIEDinfectionrequiresadditionalhospitalstay,systemicantibiotics,removalofallhardware,beforere-implantationcanoccur3CurrentStandardofCarehasImportantDeficiencies4Twomostcommonprophylacticantibiotics,IVcefazolinycin,areinadequatehavedistinctdeficienciesCefazolinhaspooractivityagainstCoagulase(-)StaphylococcusMRSAycinhaspoortissuepenetrationnoactivityagainstgram(-)rodsCurrentClinicalNeedAnadjunctiveprophylacticantibiotictherapyforCIEDimplantationGreensponAetal.JAmCollCard