title: Outcomes in patients with cardiovascular implantable electronic devices and bacteremia caused by Gram-positive cocci other than Staphylococcus aureus.
abstract: BACKGROUND
  Infection is a serious complication of cardiovascular implantable electronic device (CIED) placement and requires device removal for attempted cure.
  
  
  RESULTS
  We studied the rate, risk factors, and outcomes of CIED infection in 74 consecutive patients with bacteremia caused by Gram-positive cocci (GPC) other than Staphylococcus aureus between 2001 and 2007. CIED infection was defined as the presence of signs of infection at the generator site, lead vegetations seen on echocardiography, or microbiological growth from device cultures. Twenty-two (30%) of 74 patients with non-S aureus GPC bacteremia had CIED infections. Coagulase-negative staphylococci (CoNS) accounted for 73% of CIED infections. The rate of CIED infection in patients with CoNS bacteremia was almost 2-fold that of non-CoNS GPC bacteremia (36% versus 20%, P = 0.13). The number of leads, the presence of abandoned leads, and prior generator replacement were associated with CIED infection. Among 33 patients without identifiable CIED infection at initial evaluation who did not undergo device removal, 5 (15%) had relapsing bacteremia within 12 weeks of completing antibiotic therapy. CoNS accounted for all relapses, and none had evidence of CIED infection at relapse.
  
  
  CONCLUSIONS
  Patients with a CIED and bacteremia caused by GPC other than S aureus frequently had evidence of underlying CIED infection on clinical evaluation that included transesophageal echocardiography. This was particularly true among those with CoNS bacteremia. No evidence of underlying CIED infections was identified in the subgroup of patients who did not have manifestations of CIED infection on initial evaluation but subsequently had relapsing bacteremia caused by CoNS.
authors.affiliation: Division of Cardiovascular Diseases and Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minn, USA. madhavan.malini@mayo.edu
authors.forename: Malini
authors.initials: M
authors.lastname: Madhavan
authors.forename: Muhammad R
authors.initials: MR
authors.lastname: Sohail
authors.forename: Paul A
authors.initials: PA
authors.lastname: Friedman
authors.forename: David L
authors.initials: DL
authors.lastname: Hayes
authors.forename: James M
authors.initials: JM
authors.lastname: Steckelberg
authors.forename: Walter R
authors.initials: WR
authors.lastname: Wilson
authors.forename: Larry M
authors.initials: LM
authors.lastname: Baddour
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000628:therapy*; D016470:Bacteremia / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D017147:Defibrillators, Implantable / Q000009:adverse effects* / Q000382:microbiology; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D006095:Gram-Positive Cocci / Q000302:isolation & purification*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D011379:Prognosis; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D012189:Retrospective Studies; D013211:Staphylococcus aureus; D015996:Survival Rate; D055815:Young Adult