Cardiac implantable electronic device infection: Does the device need to be extracted?

BACKGROUND: Cardiac implantable electronic devices (CIED) have become a common treatment modality in clinical practice. The increase in utilization of these devices has been associated with an increase in infection rates. Published guidelines define when a device is deemed infected (CDI); recommendations for the work-up of CDI and criteria for extraction. Few data exist as to adherence to these guidelines. OBJECTIVE: We wanted to o evaluate whether devices diagnosed as CDI fit guidelines, whether clinicians followed work-up recommendation of CDI, and whether CIED was extracted according to the guidelines criteria in our hospital. METHODS: A retrospective review was performed in our hospital between 2008 and 2017. Adult patients (pts) 18 years and older who had their device extracted (DE) with a diagnosis of CDI were included. A total of 95 pts were identified. RESULTS: We included 95 pts who were diagnosed as having CDI and who had their DE. Work-up of patients with a diagnosis of CDI was inconsistently followed. Blood cultures, Echocardiogram, lead cultures (LC), and device pocket cultures (PC) were done in 100%, 90.5%, 75.6%, and 49.3%, respectively. Thirty out of 90 pts. (33%) did not meet guidelines criteria for extraction. CONCLUSIONS: In our institution, a one third of the pts diagnosed with CDI who had DE had no indication for DE per guidelines recommendations. Clinicians did not follow recommendations for work-up of CDI consistently. Low adherence was seen in obtaining LC and PC. CIED extraction guidelines should be followed to prevent unnecessary complications and cost.

Adenovirus, herpes simplex virus and cytomegalovirus infection in a lung transplant recipient.

Allograft infections post lung transplantation have a significant impact on morbidity and mortality. We report a rare case of triple viral infection with adenovirus, Herpes Simplex virus (HSV) and Cytomegalovirus (CMV) in a lung transplant recipient.

Herpes Simplex Virus, Cytomegalovirus, and Pneumocystis jiroveci Pneumonia in a Treatment-Naive HIV-Positive Patient with Pulmonary Alveolar Proteinosis: Case Report.

Infection with multiple pathogens concurrently has become less common since the introduction of potent antiretroviral agent and effective prophylactic agents. We describe a patient with pulmonary alveolar proteinosis (PAP) admitted with pneumonia who was found to have AIDS and diagnosed with Pneumocystis jiroveci pneumonia, human herpesvirus type 1 (HHV-1), and a concomitant cytomegalovirus viremia. Polymerase chain reaction viral load was used for diagnosis of HHV-1 and follow-up. The patient was treated with trimethoprim-sulfamethoxazole and ganciclovir and had a resolution of pneumonia. Since patients with PAP who are diagnosed as having AIDS could be concomitantly infected with multiple pathogens, rapid accurate diagnosis and treatment may have a positive effect on outcome.