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Risk of Cardiovascular Implantable Electronic Device Infection in Patients Presenting With Gram-Negative Bacteremia
Supavit Chesdachai1, Larry M Baddour1,2, M Rizwan Sohail1,3
1Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Open Forum Infectious Diseases
|September 12, 2022
Summary
Cardiovascular implantable electronic device (CIED) infection from gram-negative bacteremia (GNB) is rare. Accurate diagnosis remains challenging, necessitating further research for precise identification and appropriate management of CIED infections.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Devices
Background:
- Gram-negative bacteremia (GNB) is an uncommon cause of cardiovascular implantable electronic device (CIED) infection.
- Echocardiography may lack specificity in identifying infected CIED lead masses.
Purpose of the Study:
- To determine the incidence of CIED infection in patients with GNB.
- To evaluate diagnostic challenges in identifying CIED infections during GNB.
Main Methods:
- Retrospective analysis of 126 patients with CIED and GNB hospitalized between 2012-2019.
- Infection classification based on 2019 European Heart Rhythm Association criteria.
- Transesophageal echocardiography utilized in a subset of patients.
Main Results:
- A total of 4% (3%) patients had definite CIED infection; 3 died within 12 weeks.
- 8% (10) patients had possible CIED infection with no relapsing GNB after conservative management.
- A higher rate of CIED infection was noted with *Serratia marcescens* bacteremia.
Conclusions:
- The rate of CIED infection associated with GNB is low.
- Accurate classification of CIED infection in GNB is challenging due to low pretest probability.
- Prospective, multicenter studies are required for improved diagnostic accuracy and to guide device removal decisions.
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