Infections of Cardiac Implantable Electronic Devices: A Retrospective Multicenter Observational Study

• Published in: Medicine (Baltimore) 2012-05, Vol.91 (3), p.123-130
• Main Authors: Viola, George M., Awan, Leah L., Ostrosky-Zeichner, Luis, Chan, Wenyaw, Darouiche, Rabih O.
• Format: Article
• Language: English
• Subjects: 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
• ISSN: 0025-7974; 1536-5964
• DOI: 10.1097/MD.0b013e31825592a7

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.