Infection of Cardiac Implantable Electronic Devices in Low and Middle Income Countries: A Systematic Review.
Vithiya G, P Shunmuga Sundaram, Mangayarkarasi V
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In 30 seconds
This systematic review synthesized 55 studies of cardiac implantable electronic device (CIED) infections in low- and middle-income countries, covering 96 448 device recipients. Among 1910 infected patients, the overall infection rate was 1.65%. Rates were higher for complex devices and for replacement or revision procedures than for pacemaker implantation or de novo procedures. Coagulase-negative Staphylococci and Staphylococcus aureus were the most frequently reported organisms, while more than one-third of infections with microbiological data were culture-negative. Infection-related mortality was 8.87%, and long-term outcome data were limited.
Key findings
- Across 96 448 CIED recipients, 1910 infections were analyzed, for an overall infection rate of 1.65%.
- Infection rates were 5.9% for CRTs and 4.74% for ICDs, compared with 1.75% for pacemakers.
- Replacement and revision procedures had a 2.1% infection rate, versus 0.57% after de novo implantation.
- Among infections with microbiological data, 35.4% were culture-negative; infection-related mortality was 8.87%.
Why it matters
The review brings together evidence from settings where CIED infection data are described as limited and fragmented. Its findings highlight variation in infection rates by device type and procedure, frequent culture-negative results, and substantial infection-related mortality. These patterns underscore the importance of reliable infection surveillance and access to diagnostic and treatment resources, while the limited long-term follow-up leaves outcomes beyond the reported period uncertain.
What to keep in mind
The review reports limited long-term follow-up data; the evidence is synthesized from studies with potentially differing settings and methods.