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Outcomes in Patients with Cardiovascular Implantable Electronic Devices and Bacteremia Due to Gram-Positive Cocci Other Than Staphylococcus aureus.
Circ Arrhythm Electrophysiol. 2010 Sep 18;
Authors: Madhavan M, Sohail MR, Friedman PA, Hayes DL, Steckelberg JM, Wilson WR, Baddour LM
BACKGROUND: -Infection is a serious complication of cardiovascular implantable electronic device (CIED) placement and requires device removal for attempted cure. Methods and results-We studied the rate, risk factors and outcomes of CIED infection in 74 consecutive patients with bacteremia due to gram-positive cocci (GPC) other than Staphylococcus aureus between 2001 and 2007. CIED infection was defined as presence of signs of infection at the generator site, lead vegetations seen on echocardiography, or microbiological growth from device cultures. Twenty-two (30%) of 74 patients with non-S. aureus GPC bacteremia had CIED infections. Coagulase-negative staphylococci (CoNS) accounted for 73% of CIED infections. The rate of CIED infection in patients with CoNS bacteremia was almost two-fold that of non-CoNS GPC bacteremia (36% vs 20%, p=0.13). Number of leads, presence of abandoned leads, and prior generator replacement were associated with CIED infection. Among 33 patients without identifiable CIED infection at initial evaluation, who did not undergo device removal, 5 (15%) experienced relapsing bacteremia within 12 weeks of completing antibiotic therapy. CoNS accounted for all relapses and none of them had evidence of CIED infection at relapse. CONCLUSIONS: -Patients with a CIED and bacteremia due to GPC other than S. aureus frequently had evidence of underlying CIED infection on clinical evaluation that included transesophageal echocardiography. This was particularly true among those with CoNS bacteremia. No evidence of underlying CIED infections was identified in the subgroup of patients who did not have manifestations of CIED infection on initial evaluation, but subsequently suffered relapsing bacteremia due to CoNS.
PMID: 20852296 [PubMed - as supplied by publisher]