From the Guidelines
Electronic device infections in pediatric patients can be prevented and managed through a combination of strict hygiene practices, appropriate device handling, and prompt treatment with antibiotics if infection occurs, as recommended by the Infectious Diseases Society of America 1. The risks of electronic device-related infections in pediatric patients are significant, with studies showing that congenital heart disease is present in a large percentage of young patients with infected pacemakers, and overall infection rates ranging between 1% and 8% 1.
- Key factors contributing to infection risk include:
- Presence of Down syndrome and reintervention for revision of the pacing system 1
- Type of device and location of placement, with epicardial leads potentially necessitating extensive surgical procedures for complete device removal 1
- Patient age and underlying medical conditions, such as premature infants having an increased risk of infection due to low birth weight 1
- To prevent infections, it is essential to:
- Clean devices thoroughly with alcohol-based wipes before and after each use
- Implement a clear labeling system and dedicated storage area for shared devices
- Train staff, patients, and caregivers on proper hand hygiene and device handling
- If infection is suspected, immediate removal of the device from use and consultation with the infection control team is crucial, with treatment potentially involving thorough disinfection, device replacement, or systemic antibiotics, such as vancomycin or cefazolin, administered intravenously for 7-14 days 1.
- Regular updates and enforcement of infection control policies, as well as periodic audits, are necessary to ensure compliance and reduce infection risk in pediatric settings 1.
From the Research
Risks of Electronic Device-Related Infections in Pediatric Patients
- The risk of infection in pediatric patients with cardiac implantable electronic devices (CIED) is significantly higher compared to adults, with a tenfold higher risk of infection in children 2.
- Pediatric patients with congenital heart disease, particularly those with cyanotic heart disease, are at increased risk of developing infective endocarditis (IE), with a risk increase of more than 140 times 3.
- CIED infections can lead to life-threatening complications, including sepsis, and are associated with significant morbidity and mortality in pediatric patients 3, 4, 5.
Common Causes and Risk Factors
- Microbial contamination of the generator pocket and leads by skin flora at the time of implantation is a major mechanism for early CIED infections 6.
- Patient-related risk factors, such as comorbidities and age, can increase the risk of developing CIED infections 4, 6.
- Procedure-related risk factors, such as the use of transvenous leads, can also increase the risk of CIED infections 3, 6.
Prevention and Management Strategies
- Strict adherence to infection control measures at the time of CIED implantation is critical in reducing the risk of device infection 6.
- The use of antimicrobial envelopes and other adjunctive strategies may help reduce the risk of infection in high-risk individuals 6.
- Complete device removal and antimicrobial therapy are often required to achieve cure in cases of CIED infection 3, 5.