Intravascular device infections carry high morbidity and mortality, and are typically managed with targeted antibiotics for 4 to 6 weeks and device removal due to a lack of randomized trials.
How should intravascular device infections be managed to achieve cure?
Intravascular device infections carry high morbidity and mortality, typically requiring complete device removal and 4 to 6 weeks of targeted antibiotic therapy for definitive cure.
Intravascular devices such as pacemakers, implantable cardioverter-defibrillators (ICDs), left ventricular assist devices (LVADs), and prosthetic vascular grafts are life-saving therapies for patients with malignant arrhythmias, heart failure, and various vascular diseases. As indications for their use have increased, so has the prevalence of infectious complications associated with these devices. We present a review of the clinical literature on the epidemiology, diagnosis, and management of infectious complications of these intravascular devices. Most intravascular device infections are thought to result from skin flora contamination during implantation. Infection of the subcutaneous portion of the device can subsequently track to deeper intravascular tissues. Infection that involves the intravascular or intracardiac portion of these devices carries a high morbidity and mortality. Despite appropriate antibiotic therapy, cure of infection is frequently possible only with device removal. Well-designed placebo-controlled, randomized studies evaluating antimicrobial therapy for treatment of intravascular device infections are lacking. In the absence of better information, authorities recommend antibiotics targeted toward cultured organisms for approximately 4 to 6 weeks and device removal.
Gandelman et al. (Fri,) conducted a review in Intravascular device infections. Antimicrobial therapy and device removal was evaluated. Intravascular device infections carry high morbidity and mortality, and are typically managed with targeted antibiotics for 4 to 6 weeks and device removal due to a lack of randomized trials.