Journal Report
10/21/2003

New recommendations issued on treating device infections

DALLAS, Oct. 21 – Coronary artery stents, pacemakers, defibrillators and other devices have greatly enhanced heart disease treatment and extended patients’ lives.  While the chance of a device infection is rare, it is important that infections be treated promptly and correctly.

A new American Heart Association scientific statement, published in today’s print issue of Circulation: Journal of the American Heart Association, outlines what clinicians should know about the characteristics of cardiovascular device-related infections, and how to diagnose, treat and prevent them.  No previous document offered a comprehensive review of nonvalvular cardiovascular device infections, said the statement’s lead author Larry M. Baddour, M.D., professor of medicine in the Department of Medicine, Division of Infectious Diseases, at Mayo Clinic College of Medicine in Rochester, Minn. Other thorough reviews have detailed infection of prosthetic heart valves, so they were not addressed in this statement. 

“Patients who have cardiovascular devices should not live in fear of infection, because infectious complications are uncommon for most devices in use,” he said.  “It is imperative, however, that patients understand that infection can occur, and that they obtain from their clinicians information about signs and symptoms of device-related infections.” 

Devices vary in their risk of infection.  For some, like coronary artery stents and atrial septal defect closure buttons, complicating infection is extremely rare.  For others, such as left ventricular assist devices, the severely ill state of the patients in whom they are placed has meant that as many as 70 percent of patients have developed infections, Baddour said.

Removing the device and administering antibiotics is the best way to treat device infection.  But removal can be difficult in some patients and may require surgery.  If the device is life sustaining, it also must be replaced.

Prevention of device infection is important and the statement outlines recommendations for clinicians.  For some devices, the statement recommends using antibiotics immediately before the device is placed.  The antibiotics recommended are protective against bacteria known as staphylococci, which account for the majority of device-related infections.

Reflecting a major shift in thinking, the statement does not recommend administering antibiotics before dental procedures for patients with most cardiovascular devices.  This is noteworthy because this recommendation differs from those for patients with prosthetic heart valves in whom antibiotic use before certain dental procedures is currently recommended.

“Device-related infections are not caused by the organisms associated with dental procedures,” Baddour said.

The statement also urges that future device development include a focus on designing cardiovascular devices that are more resistant to infection and on developing antimicrobial agents capable of curing device infection without the to need to remove the device.

 “Cardiovascular device-related infections will continue to present difficult clinical challenges that demand evaluating newer devices which may include using novel materials and design to achieve the best patient outcomes,” Baddour said.

Co-authors are Michael A. Bettmann, M.D.; Ann F. Bolger, M.D.; Andrew E. Epstein, M.D.; Patricia Ferrieri, M.D.; Michael A. Gerber, M.D.; Michael H. Gewitz, M.D.; Alice K. Jacobs, M.D.; Matthew E. Levison, M.D.; Jane W. Newburger, M.D.; Thomas J. Pallasch, D.D.S.; Walter R. Wilson, M.D.; Robert S. Baltimore, M.D.; Donald A. Falace, D.M.D.; Stanford T. Shulman, M.D.; Lloyd Y. Tani, M.D. and Kathryn A. Taubert, Ph.D.

NR03-1164 (Circ/Baddour)

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