Risk factors for Gram-negative bacterial infection of cardiovascular implantable electronic devices: multicentre observational study (CarDINe Study)

Int J Antimicrob Agents. 2023 Mar;61(3):106734. doi: 10.1016/j.ijantimicag.2023.106734. Epub 2023 Jan 21.


Background: Infections of cardiovascular implantable electronic devices (CIED) are mainly due to Gram-positive bacteria (GPB). Data about Gram-negative bacteria CIED (GNB-CIED) infections are limited. This study aimed to investigate risk factors, clinical and diagnostic characteristics, and outcome of patients with GNB-CIED.

Methods: A multicentre, international, retrospective, case-control-control study was performed on patients undergoing CIED implantation from 2015 to 2019 in 17 centres across Europe. For each patient diagnosed with GNB-CIED, one matching control with GPB-CIED infection and two matching controls without infection were selected.

Results: A total of 236 patients were enrolled: 59 with GNB-CIED infection, 59 with GPB-CIED infection and 118 without infection. No between-group differences were found regarding clinical presentation, diagnostic and therapeutic management. A trend toward a higher rate of fluorodeoxyglucose positron emission computed tomography (FDG PET/CT) positivity was observed among patients with GNB than in those with GPB-CIED infection (85.7% vs. 66.7%; P = 0.208). Risk factors for GNB-CIED infection were Charlson Comorbidity Index Score (relative risk reduction, RRR = 1.211; P = 0.011), obesity (RRR = 5.122; P = 0.008), ventricular-pacing ventricular-sensing inhibited-response pacemaker implantation (RRR = 3.027; P = 0.006) and right subclavian vein site of implantation (RRR = 5.014; P = 0.004). At 180-day survival analysis, GNB-CIED infection was associated with increased mortality risk (HR = 1.842; P = 0.067).

Conclusions: Obesity, high number of comorbidities and right subclavian vein implantation site were associated with increased risk of GNB-CIED infection. A prompt therapeutic intervention that may be guided using FDG PET/CT is suggested in patients with GNB-CIED infection, considering the poorer outcome observed in this group.

Keywords: CIED infection; Cardiovascular implantable electronic devices; Endocarditis; FDG PET/CT; Gram-negative.

Publication types

  • Observational Study
  • Multicenter Study

MeSH terms

  • Cardiovascular Infections*
  • Defibrillators, Implantable* / adverse effects
  • Defibrillators, Implantable* / microbiology
  • Fluorodeoxyglucose F18
  • Gram-Negative Bacterial Infections* / complications
  • Gram-Negative Bacterial Infections* / epidemiology
  • Humans
  • Obesity
  • Positron Emission Tomography Computed Tomography / adverse effects
  • Positron Emission Tomography Computed Tomography / methods
  • Prosthesis-Related Infections* / diagnosis
  • Prosthesis-Related Infections* / epidemiology
  • Radiopharmaceuticals
  • Retrospective Studies
  • Risk Factors


  • Fluorodeoxyglucose F18
  • Radiopharmaceuticals