Infections of cardiac implantable electronic devices: a retrospective multicenter observational study

Medicine (Baltimore). 2012 May;91(3):123-30. doi: 10.1097/MD.0b013e31825592a7.

Abstract

Infections of cardiac implantable electronic devices (CIED) can cause significant morbidity, mortality, and financial burden. Although staphylococcal organisms account for most infections of these cardiac devices, approximately 20% of all CIED-related infections are caused by non-Staphylococcus species. Herein we describe and compare the demographics, clinical presentation, and outcomes of Staphylococcus aureus and non-staphylococcal infections of CIED.We performed a retrospective, multicenter, observational study of patients from 4 academic hospitals in Houston between 2002 and 2009. All 80 identified non-staphylococcal CIED-related infections were matched, at a 1:1 ratio, to S. aureus infections.Although the demographics and general comorbidities in the 2 study groups were relatively similar, the S. aureus group had a higher proportion of patients with coronary artery disease, diabetes mellitus, and end-stage renal disease. Additionally, 81% of S. aureus compared with only 48.5% of the non-staphylococcal CIED-related infections were health care-associated (p < 0.001). Furthermore, when compared to non-staphylococcal infections, the S. aureus group had more indwelling intravascular foreign material (p < 0.001), more rapid clinical progression (p < 0.001), and overall worse clinical presentation (p < 0.001). However, after stratifying by clinical presentation, the mortality rates in the 2 groups were similar (p = 0.45).Since approximately one-fifth of all CIED-related infections are caused by non-staphylococcal organisms, and untimely antibiotic treatment can result in serious complications, it may be prudent to broaden empiric antimicrobial therapy to cover both Gram-positive and -negative bacteria, until the causative organism is identified.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Anti-Bacterial Agents / therapeutic use*
  • Anti-Infective Agents / therapeutic use*
  • Arrhythmias, Cardiac / therapy*
  • Bacteremia / drug therapy
  • Bacteremia / epidemiology*
  • Bacteremia / microbiology
  • Comorbidity
  • Defibrillators, Implantable / adverse effects*
  • Defibrillators, Implantable / microbiology
  • Female
  • Humans
  • Male
  • Pacemaker, Artificial / adverse effects*
  • Pacemaker, Artificial / microbiology
  • Prosthesis-Related Infections / drug therapy
  • Prosthesis-Related Infections / epidemiology*
  • Prosthesis-Related Infections / microbiology
  • Retrospective Studies
  • Staphylococcal Infections / drug therapy
  • Staphylococcal Infections / epidemiology*
  • Staphylococcus aureus / isolation & purification*

Substances

  • Anti-Bacterial Agents
  • Anti-Infective Agents