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Drug-Resistant Gram-Positive Cocci as Etiological Factors of Cardiac Implantable Electronic Device Infections-Data

Danuta Łoboda1,2, Sylwia Gładysz-Wańha2,3, Michał Joniec2,3

  • 1Department of Electrocardiology and Heart Failure, Medical University of Silesia, 40-635 Katowice, Poland.

Antibiotics (Basel, Switzerland)
|April 27, 2026
PubMed
Abstract

Insights

Multidrug resistance (MDR) is high in Gram-positive cocci causing cardiac implantable electronic device (CIED) infections, particularly in coagulase-negative staphylococci. This highlights the need for updated empirical antibiotic strategies for CIED infections.

Area of Science:

  • Infectious Diseases
  • Medical Microbiology
  • Cardiology

Background:

  • Bacterial multidrug resistance (MDR) complicates treatment choices for infections, often necessitating the use of antibiotics with significant toxicity or suboptimal pharmacokinetic profiles.
  • Cardiac implantable electronic device (CIED) infections pose a serious threat, and the emergence of antibiotic-resistant bacteria presents a growing challenge in their management.

Purpose of the Study:

  • To determine the prevalence of multidrug-resistant (MDR) Gram-positive cocci isolated from patients with CIED infections.
  • To analyze the specific resistance patterns of key bacterial species, including staphylococci and enterococci, within this patient population.

Main Methods:

  • Data were sourced from the 'EXTRACT' registry (ClinicalTrials.gov ID NCT05775783), involving 702 transvenous lead extraction procedures.
  • Microbiological analysis included cultures from blood samples and intraoperative swabs of patients diagnosed with CIED infections.

Main Results:

  • Coagulase-negative staphylococci (CoNS) were the most frequently isolated Gram-positive cocci (67.3%), exhibiting the highest MDR rates (46.9%), including high prevalence of methicillin resistance (MR-CoNS).
  • Methicillin-resistant CoNS showed significant co-resistance to macrolides, lincosamides, fluoroquinolones, and aminoglycosides, though resistance to daptomycin and linezolid was infrequent.
  • MDR Staphylococcus aureus (MRSA) was less common (8.1%), with high co-resistance to certain antibiotic classes. Vancomycin resistance was not observed in MDR staphylococci. High-level aminoglycoside resistance (HLAR) was noted in enterococci, with varying co-resistance patterns depending on the species (E. faecalis vs. E. faecium).

Conclusions:

  • The high prevalence of MDR Gram-positive cocci, especially MR-CoNS, in CIED infections necessitates careful consideration in empirical antibiotic selection.
  • Understanding local epidemiological data on antibiotic resistance is crucial for optimizing treatment strategies and improving outcomes for patients with CIED-related infections.
Keywords:
Gram-positive cocciantimicrobial resistancecardiac implantable electronic deviceinfective endocarditismultidrug resistancepocket erosionpocket infectiontransvenous lead extraction

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