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Published on: January 7, 2019
Atypical pathogens associated with cardiac implantable electronic device infections
Utkarsh Kohli1,2, Aniruddha Hazra3, Ahmed Shahab4
1Section of Pediatric Cardiology, Department of Pediatrics, Comer Children's Hospital and the University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA.
Background:
Cardiovascular implantable electronic device (CIED) infections are associated with significant morbidity and mortality making the identification of the causative organism critical. The vast majority of CIED infections are caused by Staphylococcal species. CIED infections associated with atypical pathogens are rare and have not been systematically investigated. The objective of this study is to characterize the clinical course, management and outcome in patients with CIED infection secondary to atypical pathogens.
Methods:
Medical records of all patients who underwent CIED system extraction at the University of Chicago Medical Center between January 2010 and November 2020 were retrospectively reviewed to identify patients with CIED infection. Demographic, clinical, infection-related and outcome data were collected. CIED infections were divided into typical and atypical groups based on the pathogens isolated.
Results:
Among 356 CIED extraction procedures, 130 (37%) were performed for CIED infection. Atypical pathogens were found in 5.4% (n = 7) and included Pantoea species (n = 2), Kocuria species (n = 1), Cutibacterium acnes (n = 1), Corynebacterium tuberculostearicum (n = 1), Corynebacterium striatum (n = 1), Stenotrophomonas maltophilia (n = 1), and Pseudozyma ahidis (n = 1). All patients with atypical CIED infections were successfully treated with total system removal and tailored antibiotic therapy. There were no infection-related deaths.
Conclusions:
CIED infections with atypical pathogens were rare and associated with good outcome if diagnosed early and treated with total system removal and tailored antimicrobial therapy. Atypical pathogens cultured from blood, tissue or hardware in patients with CIED infection should be considered pathogens and not contaminants.
Insights
Infections from rare atypical pathogens in cardiovascular implantable electronic devices (CIEDs) are uncommon but treatable. Early diagnosis and system removal with antibiotics lead to good outcomes for CIED infections.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Microbiology
Background:
- Cardiovascular implantable electronic device (CIED) infections pose significant health risks.
- Staphylococcal species are the most common cause of CIED infections.
- Infections caused by atypical pathogens are rare and understudied.
Purpose of the Study:
- To characterize the clinical presentation, management strategies, and patient outcomes for CIED infections caused by atypical pathogens.
- To systematically investigate rare cases of CIED infections involving unusual microorganisms.
Main Methods:
- Retrospective review of medical records for patients undergoing CIED system extraction from January 2010 to November 2020.
- Categorization of CIED infections into typical and atypical groups based on isolated pathogens.
- Collection of demographic, clinical, infection-related, and outcome data.
Main Results:
- Out of 356 CIED extractions, 130 (37%) were for infections.
- Atypical pathogens accounted for 5.4% of CIED infections, including species like Pantoea, Kocuria, and Cutibacterium acnes.
- All patients with atypical CIED infections achieved successful treatment via system removal and targeted antibiotics, with no infection-related mortality.
Conclusions:
- CIED infections due to atypical pathogens are infrequent but have favorable outcomes with prompt diagnosis and treatment.
- Early identification and comprehensive management, including total system extraction and tailored antibiotic therapy, are crucial for resolving atypical CIED infections.
- Atypical organisms isolated from CIED sites should be considered true pathogens, not contaminants, guiding appropriate clinical management.
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