title: Nonstaphylococcal infections of cardiac implantable electronic devices.
abstract: BACKGROUND
  Along with the rising use of cardiac implantable electronic devices (CIEDs), there has been a disproportional increase in the number of infections of such devices. Little is known about nonstaphylococcal CIED-related infections, which make up approximately 10% to 30% of all CIED infections.
  
  
  RESULTS
  A retrospective review of hospital records of patients admitted with a CIED-related infection was conducted in 4 academic hospitals in Houston, Tex, between 2002 and 2009. Of the 504 identified patients with CIED-related infection, 80 (16%) had a nonstaphylococcal infection and were the focus of this study. The mean duration of CIED placement before infection was 109+/-27 weeks, whereas 44% had their device previously manipulated within a mean of 29.5+/-6 weeks. The mean duration of clinical symptoms before admission was 48+/-12.8 days. Furthermore, 13 patients (16%) presented with CIED-related endocarditis. Although not described in prior reports, we identified 3 definite and 2 suspected cases of secondary Gram-negative bacteria seeding of the CIED. Inappropriate antimicrobial coverage was provided in approximately 50% of the cases with a mean period of 2.1 days. The overall mortality rate was 4%.
  
  
  CONCLUSIONS
  Nonstaphylococcal CIED-related infections are prevalent and diverse with a relatively low virulence and mortality rate. Because nonstaphylococcal organisms are capable of secondarily seeding the CIED, a high suspicion for CIED-related infection is warranted in patients with bloodstream infection. In patients with suspected CIED infection, adequate Gram-positive and Gram-negative antibacterial coverage should be administered until microbiological data become available.
authors.affiliation: Baylor College of Medicine, Department of Medicine, Section of Infectious Diseases, One Baylor Plaza, BCM 286, Room N1319, Houston, TX 77030, USA. viola@bcm.edu
authors.forename: George M
authors.initials: GM
authors.lastname: Viola
authors.forename: Leah L
authors.initials: LL
authors.lastname: Awan
authors.forename: Rabih O
authors.initials: RO
authors.lastname: Darouiche
mesh_terms: D017147:Defibrillators, Implantable / Q000009:adverse effects / Q000382:microbiology* / Q000706:statistics & numerical data; D004696:Endocarditis / Q000382:microbiology / Q000401:mortality; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000401:mortality*; D016908:Gram-Positive Bacterial Infections / Q000401:mortality*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010138:Pacemaker, Artificial / Q000009:adverse effects / Q000382:microbiology* / Q000706:statistics & numerical data; D015995:Prevalence; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000401:mortality*; D012189:Retrospective Studies; D018805:Sepsis / Q000382:microbiology / Q000401:mortality