title: Microbiologic characteristics and in vitro susceptibility to antimicrobials in a large population of patients with cardiovascular implantable electronic device infection.
abstract: BACKGROUND
  The incidence of cardiovascular implantable electronic device (CIED) infection is steadily increasing. However, no consensus has been reached with respect to the type and duration of antimicrobial therapy in this specific population of patients. The role played by new anti-Staphylococcus agents has not been defined. The aims of this study were to describe the microbiological characteristics of a large population of patients with CIED infections and to test the in vitro susceptibility of the various strains to different antimicrobials.
  
  
  METHODS
  Two hundred eighty-six patients with CIED infection were included. The minimal inhibitory concentrations of 9 antimicrobials, including linezolid, tigecycline, and daptomycin were measured against all strains of staphylococci isolated.
  
  
  RESULTS
  Microbiologic confirmation was obtained in 252 (88%) patients, the vast majority were from Staphylococcus species (86%), 90% of these were coagulase negative strains and 10% were Staphylococcus aureus; 30.5% were methicillin-resistant. All strains were susceptible to vancomycin, nearly 15% of coagulase negative strains were nonsusceptible to teicoplanin, and nearly 100% of the strains were susceptible to the 3 new antimicrobials.
  
  
  CONCLUSIONS
  In this large contemporary study, we show that Staphylococcus is by far the most common cause of CIED infections, with the majority due to coagulase negative strains. Methicillin-resistance is common in this population. Currently, we would recommend vancomycin as first-line empirical therapy. However, given that not all patients tolerate vancomycin, we believe that newer antimicrobial therapies should now be tested in clinical trials to establish their clinical effectiveness in treating patients with device infections.
authors.affiliation: University Hospital of Bordeaux, Bordeaux, France.
authors.forename: Emilie
authors.initials: E
authors.lastname: Jan
authors.forename: Fabrice
authors.initials: F
authors.lastname: Camou
authors.forename: Jeannette
authors.initials: J
authors.lastname: Texier-Maugein
authors.forename: Zachary
authors.initials: Z
authors.lastname: Whinnett
authors.forename: Olivier
authors.initials: O
authors.lastname: Caubet
authors.forename: Sylvain
authors.initials: S
authors.lastname: Ploux
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Pellegrin
authors.forename: Philippe
authors.initials: P
authors.lastname: Ritter
authors.forename: Philippe L
authors.initials: PL
authors.lastname: Metayer
authors.forename: Raymond
authors.initials: R
authors.lastname: Roudaut
authors.forename: Michel
authors.initials: M
authors.lastname: Haissaguerre
authors.forename: Pierre
authors.initials: P
authors.lastname: Bordachar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D058409:Cardiac Resynchronization Therapy Devices / Q000382:microbiology*; D016009:Chi-Square Distribution; D020878:Device Removal; D052978:Disk Diffusion Antimicrobial Tests; D024901:Drug Resistance, Multiple, Bacterial; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D004866:Equipment Contamination; D004867:Equipment Design; D005602:France; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000382:microbiology*; D011237:Predictive Value of Tests; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D013211:Staphylococcus aureus / Q000145:classification / Q000187:drug effects* / Q000302:isolation & purification; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents