Complications of cardiac implants: handling device infections.

2012

Nof E, Epstein LM.

Source

Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.

Abstract

Managing patients with cardiac implantable electrophysiological devices (CIED) infections can be challenging. The first step should be prevention, which involves patient selection, timing of implantation, and the procedure itself. After implantation, a high degree of suspicion should be applied in order to correctly diagnose patients with infected implanted devices. It is necessary to recognize that patients can present with a wide variety of signs and symptoms. Once diagnosed, the next step is determining if it is a local pocket infection or system infection. In almost every patient, in addition to antibiotics, complete removal of ALL hardware is required. Transvenous lead extraction is now safe and effective, but should only be performed at experienced centres with a practiced extraction team, all possible needed equipment, and cardiothoracic surgical backup. After extraction, the indication for CIED therapy should be re-evaluated to determine re-implantation is warranted. Timing of re-implantation depends on a variety of factors such as type of infection or valvular involvement and should be made in concordance with an infectious disease specialist. This review is aimed at introducing the steps needed to manage patients with infected cardiac devices.

PubMed

Appendicitis could be treated with antibiotics rather than surgery 

Friday Sept 28, 2012

Eight out of ten cases of appendicitis could be treated with antibiotics rather than surgery, a trial suggests.

A study found that although the standard approach to appendicitis is to remove the appendix, treatment with antibiotics can be just as effective.

Jeanette Hansson, of the University of Gothenburg, examined two clinical studies of adult patients with acute appendicitis.

She compared those who had received treatment with just antibiotics to those who had surgery with antibiotic therapy.

Ms Hansson says in her thesis, carried out at Sahlgrenska University Hospital and Kungälv Hospital, that treatment with antibiotics was just as effective as surgery for the majority of patients.

She said: "Some patients are so ill that the operation is absolutely necessary, but 80 percent of those who can be treated with antibiotics recover and return to full health," says Jeanette Hansson.

The thesis also showed that patients who are treated with antibiotics are at risk of fewer complications than those who undergo surgery.

The risk of reoccurence within 12 months of antibiotic treatment is between ten and 15 per cent, but Ms Hansson said the medicine is still a viable alternative to surgery.

She said: "It's important to note that our studies show that patients who need surgery because of recurrences, or because the antibiotics haven't worked, are not at risk of any additional complications relative to those operated on in the first place."

The Telegraph