Supavit Chesdachai1, Larry M Baddour2, M Rizwan Sohail3, Bharath Raj Palraj4, Malini Madhavan5, Hussam Tabaja4, Madiha Fida6, Brian D Lahr7, Daniel C DeSimone2. 1. Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota. Electronic address: chesdachai.supavit@mayo.edu. 2. Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota; Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota. 3. Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota; Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, Texas. 4. Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota. 5. Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota. 6. Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota; Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota. 7. Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota.
Abstract
BACKGROUND: Cardiovascular implantable electronic device (CIED) implantation has markedly increased over the past 2 decades. Staphylococcus aureus bacteremia (SAB) occurs in patients with CIED, and determination of device infection often is difficult. OBJECTIVES: The purpose of this study was to examine the rate and clinical characteristics of SAB in patients living with CIED using the 2019 European Heart Rhythm Association (EHRA) international consensus document. METHODS: We conducted a retrospective study of patients with CIED who were hospitalized at Mayo Clinic, Rochester, with SAB from 2012 to 2019. Patients who met CIED infection criteria after SAB based on EHRA criteria were identified. A descriptive statistic and time-dependent Cox model were used. RESULTS: Overall, 110 patients with CIED developed SAB, of whom 92 (83.6%) underwent transesophageal echocardiogram (TEE). Fifty-seven (51.8%) and 31 (28.2%) patients met criteria for definite and possible CIED infections, respectively. At 30-day follow-up, the cumulative rate of patients undergoing complete device extraction was 80.0% in the definite CIED infection group, compared with 38.8% and 32.9% in the possible and rejected CIED infection groups, respectively. We found that CIED extraction was associated with an 83% reduction in risk of 1-year mortality in the definite CIED infection group. CONCLUSION: The rate of CIED infections after SAB was higher than that reported previously. Increased use of TEE and a novel case definition with broader diagnostic criteria likely were operative, in part, in accounting for the higher rate of CIED infections complicating SAB. Complete device removal is critical in patients with definite CIED infection to improve 1-year mortality.
BACKGROUND: Cardiovascular implantable electronic device (CIED) implantation has markedly increased over the past 2 decades. Staphylococcus aureus bacteremia (SAB) occurs in patients with CIED, and determination of device infection often is difficult. OBJECTIVES: The purpose of this study was to examine the rate and clinical characteristics of SAB in patients living with CIED using the 2019 European Heart Rhythm Association (EHRA) international consensus document. METHODS: We conducted a retrospective study of patients with CIED who were hospitalized at Mayo Clinic, Rochester, with SAB from 2012 to 2019. Patients who met CIED infection criteria after SAB based on EHRA criteria were identified. A descriptive statistic and time-dependent Cox model were used. RESULTS: Overall, 110 patients with CIED developed SAB, of whom 92 (83.6%) underwent transesophageal echocardiogram (TEE). Fifty-seven (51.8%) and 31 (28.2%) patients met criteria for definite and possible CIED infections, respectively. At 30-day follow-up, the cumulative rate of patients undergoing complete device extraction was 80.0% in the definite CIED infection group, compared with 38.8% and 32.9% in the possible and rejected CIED infection groups, respectively. We found that CIED extraction was associated with an 83% reduction in risk of 1-year mortality in the definite CIED infection group. CONCLUSION: The rate of CIED infections after SAB was higher than that reported previously. Increased use of TEE and a novel case definition with broader diagnostic criteria likely were operative, in part, in accounting for the higher rate of CIED infections complicating SAB. Complete device removal is critical in patients with definite CIED infection to improve 1-year mortality.
Authors: Paola Anna Erba; Francesco Bartoli; Martina Sollini; Berchiolli Raffaella; Roberta Zanca; Esposito Enrica; Elena Lazzeri Journal: Curr Cardiol Rep Date: 2022-06-13 Impact factor: 3.955
Authors: Supavit Chesdachai; Larry M Baddour; M Rizwan Sohail; Bharath Raj Palraj; Malini Madhavan; Hussam Tabaja; Madiha Fida; Brian D Lahr; Daniel C DeSimone Journal: Open Forum Infect Dis Date: 2022-08-25 Impact factor: 4.423