Catheter and Line Related IE

Intravascular and intracardiac catheters and devices have proliferated and now include pacemakers, defibrillators, indwelling heart catheters, grafts, and valve or non-valve prosthe-ses. These foreign bodies may be the nidus for infection and may also lead to thrombus formation on a neighboring structures or heart valves [11]. Insertions of catheters, pacemakers, and cannulas are routine procedures in modern medical therapy for resuscitation, feeding, hemodynamic monitoring, and therapy of disease [12,13]. Lines or catheters may contuse, tear, penetrate, perforate, tangle, or thrombose the intracardiac structures. Biofilms of infecting organisms and extracellular matrix may form on the surface of lines or devices and serve as a protective environment for the infective organisms [11,14].

The most common catheter- or line-related lesions involve the right atrium, right ventricle, pulmonary, and tricuspid valves [12,15]. These lesions are rarely important unless they are infected [12]. The catheter lesions are located on the atrial side of the tricuspid valve or on the ventricular side of the pulmonary valve [15]. The lesions usually follow the line of the catheter and the catheter may be surrounded by thrombus which chronically may organize and fibrose.

Infections in defibrillators and pacemakers may occur anywhere along the electrode and are not limited to the tricuspid valve [11]. Pacemakers and defibrillators may have infection involving either the lead or the pouch, and Staphylococci are the most common pathogens involved [16]. Fungal infection may also be seen [17]. Septic and bland pulmonary emboli may complicate pacemaker/defibrillator infection. If the device has been in place for some time, lead extraction is usually impossible and open-heart surgery may be necessary.

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