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Adherence to diagnostic and therapeutic practice guidelines for suspected cardiac implantable electronic device infections
Archives of Cardiovascular Diseases ( IF 3 ) Pub Date : 2021-11-03 , DOI: 10.1016/j.acvd.2021.06.010
Guillaume De Ciancio 1 , Marie-Line Erpelding 2 , Laura Filippetti 1 , François Goehringer 3 , Hugues Blangy 1 , Olivier Huttin 4 , Nelly Agrinier 5 , Yves Juillière 4 , Nicolas Sadoul 4 , Christine Selton-Suty 1
Affiliation  

Background

Despite guidelines describing the optimal diagnostic and therapeutic procedures for patients with suspected cardiac implantable electronic device (CIED) infections, their management is often challenging.

Aims

To describe our diagnostic and therapeutic practices for suspected CIED infection, and to compare them with European Heart Rhythm Association (EHRA) guidelines.

Methods

Patients hospitalized in the tertiary care Nancy University Hospital for suspected CIED infection from 2014 to 2019 were included retrospectively. We applied the EHRA classification of CIED infection, and compared diagnostic and therapeutic management with the EHRA guidelines.

Results

Among 184 patients (mean age 72.3 ± 12.4 years), 137 had a proven infection of the lead (by transthoracic echocardiography/transoesophageal echocardiography, 18F-fluorodesoxyglucose positron emission tomography/computed tomography or positive culture of the lead) or an isolated pocket infection without proof of lead infection, and 47 had no proof of CIED infection. According to the EHRA classification, CIED infection was considered as definite in 145 patients and possible in 31 and was excluded in eight patients. Regarding recommended diagnostic procedures, blood cultures were performed in 90.8%, transthoracic echocardiography in 97.8%, transoesophageal echocardiography in 85.9%, 18F-fluorodesoxyglucose positron emission tomography/computed tomography in 50.5% and imaging for embolisms in 78.3% of the patients. Compared with therapeutic recommendations for the 145 cases of definite CIED infection, device removal was performed in 96 patients (66.2%) and antibiotic therapy was prescribed in 130 (89.7%), with a duration equal to or longer than that recommended in 105 (72.4%) of the patients.

Conclusion

This study underlines the difficulties in following theoretical guidelines in daily practice, where both technical and human considerations interfere with their strict appliance.



中文翻译:

遵守疑似心脏植入式电子设备感染的诊断和治疗实践指南

背景

尽管指南描述了疑似心脏植入式电子设备 (CIED) 感染患者的最佳诊断和治疗程序,但他们的管理往往具有挑战性。

宗旨

描述我们对疑似 CIED 感染的诊断和治疗实践,并将其与欧洲心律协会 (EHRA) 指南进行比较。

方法

回顾性纳入了 2014 年至 2019 年因怀疑 CIED 感染而在三级保健南锡大学医院住院的患者。我们应用了 CIED 感染的 EHRA 分类,并将诊断和治疗管理与 EHRA 指南进行了比较。

结果

在 184 名患者(平均年龄 72.3  ±  12.4 岁)中,137 名被证实感染了铅(经胸超声心动图/经食道超声心动图、18 F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描或铅培养阳性)或孤立的口袋感染没有铅感染的证据,47 人没有 CIED 感染的证据。根据 EHRA 分类,CIED 感染在 145 名患者中被认为是明确的,在 31 名患者中被认为是可能的,并且有 8 名患者被排除在外。关于推荐的诊断程序,90.8% 进行了血培养,97.8% 进行了经胸超声心动图检查,85.9% 进行了经食管超声心动图检查,1850.5% 的 F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描和 78.3% 的患者栓塞成像。与 145 例明确 CIED 感染的治疗建议相比,96 例患者(66.2%)进行了器械移除,130 例(89.7%)患者开具了抗生素治疗,持续时间等于或长于 105 例(72.4 %) 的患者。

结论

这项研究强调了在日常实践中遵循理论指导的困难,在这些实践中,技术和人为因素都会干扰其严格的应用。

更新日期:2021-11-25
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