Cardiac Implantable Electronic Device Infections and Lead Extraction
Are Patients With Renal Insufficiency Special?
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- cardiac pacing, artificial
- defibrillators, implantable
- renal insufficiency
See Article by Barakat et al
The implantation of cardiac implantable electronic devices (CIED) for the treatment of bradyarrhythmia and tachyarrhythmia has increased significantly during the past 30 years.1,2 Along with the increase in CIED implantation has been a steady and at times disproportional rise in device-related infections.3,4 Among Medicare beneficiaries between 1990 and 1999, there has been an increase in CIED-related infections from 0.94 to 2.11 per 1000,5 which has been validated in other cohorts.6,7 On the basis of the National Hospital Discharge Survey between 2004 and 2006, there was a 57% increase in CIED infections along with a steady rise in the prevalence of patients undergoing CIED implantation who have end-organ failure and diabetes mellitus.4 Known risk factors for CIED infection have been well established in multiple studies to include diabetes mellitus, generator replacement, anticoagulation use, multiple lead insertion, and renal dysfunction. The latter have been found to be one of the strongest risk factors (odds ratio 4.8).8,9 Among CIED patients with bacteremia, the most common organism is Staphylococcus aureus,10 …