A summary of the update on cardiovascular implantable electronic device infections and their management: a scientific statement from the American Heart Association.

BACKGROUND: The purpose of this statement is to update the recommendations by the American Heart Association (AHA) for cardiovascular implantable electronic device (CIED) infections and their management, which were last published in 2003. METHODS AND RESULTS: The AHA commissioned this scientific statement to educate clinicians about CIED infections, provide explicit recommendations for the care of patients with suspected or established CIED infections and highlight areas of needed research. The recommendations in this statement reflect analyses of relevant literature, to include recent advances in our understanding of the epidemiology, risk factors, microbiology, management and prevention of CIED infections. CONCLUSION: There are no scientific data to support the use of antimicrobial prophylaxis for dental or other invasive procedures. CLINICAL IMPLICATIONS: The concerns about life-threatening drug reactions, the development of resistant strains of bacterial pathogens, medicolegal issues and cost to the health care system are, thus, avoided.

Update on cardiovascular implantable electronic device infections and their management: a scientific statement from the American Heart Association.

Despite improvements in cardiovascular implantable electronic device (CIED) design, application of timely infection control practices, and administration of antibiotic prophylaxis at the time of device placement, CIED infections continue to occur and can be life-threatening. This has prompted the study of all aspects of CIED infections. Recognizing the recent advances in our understanding of the epidemiology, risk factors, microbiology, management, and prevention of CIED infections, the American Heart Association commissioned this scientific statement to educate clinicians about CIED infections, provide explicit recommendations for the care of patients with suspected or established CIED infections, and highlight areas of needed research.

Use of both internal thoracic arteries in diabetic patients increases deep sternal wound infection.

BACKGROUND: Use of both internal thoracic arteries has been limited in diabetic patients fearing an increased incidence of deep sternal wound infection. We analyzed this concern by querying The Society of Thoracic Surgeons Database. METHODS: Diabetic patients who had isolated coronary artery bypass graft surgery during 2002 to 2004 were included if they had no prior bypass surgery, two or more distal bypasses, and a left internal thoracic artery bypass. Group B (both internal thoracic arteries) was compared with group L (left internal thoracic artery only). RESULTS: The incidence of deep sternal wound infection for all patients undergoing isolated first-time bypass surgery was less than 1%. Of these, 120,793 patients met criteria for inclusion: group B, 1.4% (1732); and group L, 98.6% (119,061). Group B had a higher crude (unadjusted) deep sternal wound infection rate of 2.8% (49) versus 1.7% (1969; p = 0.0005) in group L, with an estimated odds ratio of 2.23 (95% confidence interval, 1.69 to 2.96). Group B had a similar crude mortality rate of 1.7% (30) versus 2.3% (2785; p = NS) in group L, with an estimated odds ratio of 1.110 (95% CI, 0.78 to 1.59; p = NS). Patients in group B were younger, mostly male, had a lower serum creatinine level, and were more often current smokers; less commonly, they were insulin dependent, diagnosed with pulmonary or vascular disease, or on dialysis. Other risk factors for deep sternal would infection included female gender, insulin dependence, peripheral vascular disease, recent infarction, body mass index exceeding 35 kg/m2, and use of blood products. CONCLUSIONS: There is a significant increase in the incidence of deep sternal would infection in diabetic patients. This is further increased with the use of both internal thoracic arteries with no apparent short-term mortality difference.