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Predictors of Bloodstream Infection in Patients Presenting With Cardiovascular Implantable Electronic Device Pocket
Zerelda Esquer Garrigos1, Merit P George1, Sarwat Khalil1
1Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester Minnesota.
Insights
Predictors of bloodstream infection (BSI) in patients with cardiovascular implantable electronic device (CIED) pocket infections were identified. Systemic inflammatory response syndrome criteria and hypotension indicate a higher likelihood of BSI.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Device Infections
Background:
- Generator pocket infection is the most common presentation of cardiovascular implantable electronic device (CIED) infections.
- Identifying predictors of bloodstream infection (BSI) in these patients is crucial for appropriate management.
Purpose of the Study:
- To identify independent predictors of underlying bloodstream infection (BSI) in patients presenting with CIED pocket infection.
Main Methods:
- Retrospective review of adult patients with CIED pocket infection from January 2005 to January 2016.
- Cases were subclassified as with or without associated BSI.
- Multivariable analysis was used to identify independent predictors of BSI.
Main Results:
- Of 95 CIED infection cases, 28.4% had associated BSI.
- Systemic inflammatory response syndrome criteria and hypotension were independent predictors of BSI.
- Patients without BSI who did not receive pre-extraction antibiotics had higher positive intraoperative culture rates.
Conclusions:
- Patients with CIED pocket infection meeting systemic inflammatory response syndrome criteria or presenting with hypotension are likely to have underlying BSI.
- Empiric antibiotics should be initiated after blood cultures in such cases.
- Withholding empiric antibiotics when these features are absent may optimize culture yield during device extraction.
Background:
Generator pocket infection is the most frequent presentation of cardiovascular implantable electronic device (CIED) infection. We aim to identify predictors of underlying bloodstream infection (BSI) in patients presenting with CIED pocket infection.
Methods:
We retrospectively reviewed all adults with CIED pocket infection cared for at our institution from January 2005 through January 2016. The CIED pocket infection cases were then subclassified as with or without associated BSI. Variables with P values <.05 at univariate analysis were included in a multivariable model to identify independent predictors of underlying BSI.
Results:
We screened 429 cases of CIED infection, and 95 met the inclusion criteria. Of these, 68 cases (71.6%) were categorized as non-BSI and 27 (28.4%) as BSI. There were no statistically significant differences in patient comorbid conditions or device characteristics between the 2 groups. In multivariable analysis, the presence of systemic inflammatory response syndrome criteria (tachycardia, tachypnea, fever or hypothermia, and leukocytosis or leukopenia) and hypotension were independent predictors of underlying BSI in patients presenting with CIED pocket infection. Overall, patients in the non-BSI group who did not receive pre-extraction antibiotics had a higher frequency of positive intraoperative pocket/device cultures than those with pre-extraction antibiotic exposure (79.4% vs 58.6%; P = .06).
Conclusions:
Patients with CIED pocket infection who meet systemic inflammatory response syndrome criteria and/or are hypotensive at admission are more likely to have underlying BSI and should be started on empiric antibiotics after blood cultures are obtained. If these features are absent, it may be reasonable to withhold empiric antibiotics to optimize yield of pocket/device cultures during extraction.
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