Related Experiment Video
Updated: Jun 30, 2025
Author Spotlight: Advancing Research on Candida albicans Biofilm-Associated Prosthetic Joint Infections
Published on: February 2, 2024
Outcome and microbiological findings of patients with cardiac implantable electronic device infection
Lara C Schipmann1,2, Viviane Moeller3, Juliane Krimnitz3
1Department of Cardiology, Faculty of Health Sciences (FGW) Brandenburg, Heart Center Brandenburg Bernau, Brandenburg Medical School (MHB) Theodor Fontane, Ladeburger Straße 17, 16321, Bernau Bei Berlin, Germany. lara.schipmann@gmail.com.
Insights
Cardiac implantable electronic device (CIED) infections increase mortality, with age, NT-proBNP, tricuspid regurgitation, and systemic infection being key risk factors for 1-year mortality. Coagulase-negative staphylococci show higher antibiotic resistance.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Device Infections
Background:
- Infections associated with cardiac implantable electronic devices (CIEDs) significantly increase patient morbidity and mortality.
- Understanding risk factors is crucial for managing these complex infections.
Purpose of the Study:
- To analyze patient, disease, and treatment characteristics, including microbiological data, in relation to survival status.
- To identify independent risk factors for 1- and 3-year mortality in patients with local or systemic CIED infections.
Main Methods:
- Retrospective cohort study of 243 patients undergoing transvenous lead extraction (TLE) for CIED infection.
- Analysis of survival status, rehospitalization rates, microbiology, and first-line antibiotic therapy.
- Determination of independent risk factors for 1- and 3-year mortality.
Main Results:
- In-hospital mortality was 2.5%; 1-year and 3-year mortality rates were 18.1% and 30%, respectively.
- Independent risk factors for 1-year mortality included older age, elevated NT-proBNP, new/worsened tricuspid regurgitation post-TLE, and systemic infection.
- Systemic infection was not an independent risk factor for 3-year mortality; Staphylococci were common, with higher antibiotic resistance in coagulase-negative strains.
Conclusions:
- Staphylococci, particularly coagulase-negative strains, are the most frequent pathogens in CIED infections, often exhibiting antibiotic resistance.
- Identified risk factors can aid in individual risk stratification and treatment decisions for CIED infections.
- Further research into tricuspid regurgitation as a post-TLE complication is warranted.
Introduction:
Infections associated with cardiac implantable electronic devices (CIEDs) are a multifactorial disease that leads to increased morbidity and mortality.
Objective:
The aim was to analyze patient-, disease- and treatment-related characteristics including microbiological and bacterial spectrum according to survival status and to identify risk factors for 1- and 3-year mortality in patients with local and systemic CIED infection.
Methods:
In a retrospective cohort study, we analyzed data from patients with CIED-related local or systemic infection undergoing successful transvenous lead extraction (TLE). Survival status as well as incidence and cause of rehospitalization were recorded. Microbiology and antibiotics used as first-line therapy were compared according to mortality. Independent risk factors for 1- and 3-year mortality were determined.
Results:
Data from 243 Patients were analyzed. In-hospital mortality was 2.5%. Mortality rates at 30 days, 1- and 3 years were 4.1%, 18.1% and 30%, respectively. Seventy-four (30.5%) patients had systemic bacterial infection. Independent risk factors for 1-year mortality included age (OR 1.05 [1.01-1.10], p = 0.014), NT-proBNP at admission (OR 4.18 [1.81-9.65], p = 0.001), new onset or worsened tricuspid regurgitation after TLE (OR 6.04 [1.58-23.02], p = 0.009), and systemic infection (OR 2.76 [1.08-7.03], p = 0.034), whereas systemic infection was no longer an independent risk factor for 3-year mortality. Staphylococcus aureus was found in 18.1% of patients who survived and in 25% of those who died, p = 0.092. There was a high proportion of methicillin-resistant strains among coagulase-negative staphylococci (16.5%) compared to Staphylococcus aureus (1.2%).
Conclusions:
Staphylococci are the most common causative germs of CIED-infection with coagulase-negative staphylococci showing higher resistance rates to antibiotics. The independent risk factors for increased long-term mortality could contribute to individual risk stratification and well-founded treatment decisions in clinical routine. Especially the role of tricuspid regurgitation as a complication after TLE should be investigated in future studies.
