Unbound MEDLINE

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

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.

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  • Authors

    Viola GM, Awan LL, Ostrosky-Zeichner L, Chan W, Darouiche RO

    Institution

    Division of Infectious Diseases, Department of Medicine, University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA. GMViola@mdanderson.org

    Source

    Medicine 91:3 2012 May pg 123-30

    MeSH

    Anti-Bacterial Agents
    Anti-Infective Agents
    Arrhythmias, Cardiac
    Bacteremia
    Comorbidity
    Defibrillators, Implantable
    Female
    Humans
    Male
    Pacemaker, Artificial
    Prosthesis-Related Infections
    Retrospective Studies
    Staphylococcal Infections
    Staphylococcus aureus

    Pub Type(s)

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

    Language

    eng

    PubMed ID

    22543626