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Risk factors for Gram-negative bacterial infection of cardiovascular implantable electronic devices: multicentre

Renato Pascale1, Alice Toschi2, Abdullah Tarik Aslan3

  • 1Infectious Diseases Unit, Department of Integrated Management of Infectious Risk, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.

International Journal of Antimicrobial Agents
|January 23, 2023
PubMed

Insights

Gram-negative bacteria (GNB) infections of cardiovascular implantable electronic devices (CIED) are linked to higher mortality. Obesity, comorbidities, and specific implantation sites increase GNB-CIED infection risk, suggesting prompt, FDG PET/CT-guided intervention.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Medical Device Infections

Background:

  • Cardiovascular implantable electronic device (CIED) infections are predominantly caused by Gram-positive bacteria (GPB).
  • Limited data exists on Gram-negative bacteria CIED (GNB-CIED) infections, necessitating further investigation into their specific characteristics and outcomes.

Purpose of the Study:

  • To investigate the risk factors, clinical presentation, diagnostic methods, and patient outcomes associated with GNB-CIED infections.
  • To compare GNB-CIED infections with GPB-CIED infections and uninfected controls.

Main Methods:

  • A multicenter, international, retrospective, case-control study involving 236 patients from 17 European centers (2015-2019).
  • Patients with GNB-CIED infection were matched with controls having GPB-CIED infection and no infection.
  • Data collected included clinical, diagnostic, and therapeutic management, as well as survival analysis.

Main Results:

  • No significant differences in clinical presentation or management were observed between GNB-CIED and GPB-CIED groups.
  • Higher fluorodeoxyglucose positron emission computed tomography (FDG PET/CT) positivity trended in GNB-CIED patients (85.7% vs. 66.7%).
  • Risk factors for GNB-CIED infection included higher Charlson Comorbidity Index Score, obesity, specific pacemaker implantation (ventricular-pacing ventricular-sensing inhibited-response), and right subclavian vein site. GNB-CIED infection was associated with increased 180-day mortality risk (HR=1.842).

Conclusions:

  • Obesity, high comorbidity burden, and right subclavian vein implantation are significant risk factors for GNB-CIED infections.
  • Prompt therapeutic intervention, potentially guided by FDG PET/CT, is recommended for GNB-CIED infections due to poorer outcomes.
Abstract

Keywords:
CIED infectionCardiovascular implantable electronic devicesEndocarditisFDG PET/CTGram-negative

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