Bacteremia Due to Non-Staphylococcus aureus Gram-Positive Cocci and Risk of Cardiovascular Implantable Electronic Device Infection

Authors

Supavit Chesdachai
Larry M Baddour
M Rizwan Sohail
Bharath Raj Palraj
Malini Madhavan
Hussam Tabaja
Madiha Fida
Brian D Lahr
Daniel C DeSimone

Publication Date

3-1-2023

Journal

Heart Rhythm O2

DOI

10.1016/j.hroo.2022.12.010

PMID

36993918

PMCID

PMC10041087

PubMedCentral® Posted Date

12-22-2022

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

Bacteremia, Cardiovascular implantable electronic device, Consensus document, Infection, Definition, Non–Staphylococcus aureus gram-positive cocci, Outcomes

Abstract

BACKGROUND: Cardiovascular implantable electronic device (CIED) infection carries significant morbidity and mortality with bacteremia being a possible marker of device infection. A clinical profile of non-Staphylococcus aureus gram-positive cocci (non-SA GPC) bacteremia in patients with CIED has been limited.

OBJECTIVE: To examine characteristics of patients with CIED who developed non-SA GPC bacteremia and risk of CIED infection.

METHODS: We reviewed all patients with CIED who developed non-SA GPC bacteremia at the Mayo Clinic between 2012 and 2019. The 2019 European Heart Rhythm Association Consensus Document was used to define CIED infection.

RESULTS: A total of 160 patients with CIED developed non-SA GPC bacteremia. CIED infection was present in 90 (56.3%) patients, in whom 60 (37.5%) were classified as definite and 30 (18.8%) as possible. This included 41 (45.6%) cases of coagulase-negative Staphylococcus (CoNS), 30 (33.3%) cases of Enterococcus, 13 (14.4%) cases of viridans group streptococci (VGS), and 6 (6.7%) cases of other organisms. The adjusted odds of CIED infection in cases due to CoNS, Enterococcus, and VGS bacteremia were 19-, 14-, and 15-fold higher, respectively, as compared with other non-SA GPC. In patients with CIED infection, the reduction in risk of 1-year mortality associated with device removal was not statistically significant (hazard ratio 0.59; 95% confidence interval 0.26–1.33; P = .198).

CONCLUSIONS: The prevalence of CIED infection in non-SA GPC bacteremia was higher than previously reported, particularly in cases due to CoNS,

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