Predictors of Bloodstream Infection in Patients Presenting With Cardiovascular Implantable Electronic Device Pocket...

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.