title: Infections of cardiac implantable electronic devices: a retrospective multicenter observational study.
abstract: Infections of cardiac implantable electronic devices (CIED) can cause significant morbidity, mortality, and financial burden. Although staphylococcal organisms account for most infections of these cardiac devices, approximately 20% of all CIED-related infections are caused by non-Staphylococcus species. Herein we describe and compare the demographics, clinical presentation, and outcomes of Staphylococcus aureus and non-staphylococcal infections of CIED.We performed a retrospective, multicenter, observational study of patients from 4 academic hospitals in Houston between 2002 and 2009. All 80 identified non-staphylococcal CIED-related infections were matched, at a 1:1 ratio, to S. aureus infections.Although the demographics and general comorbidities in the 2 study groups were relatively similar, the S. aureus group had a higher proportion of patients with coronary artery disease, diabetes mellitus, and end-stage renal disease. Additionally, 81% of S. aureus compared with only 48.5% of the non-staphylococcal CIED-related infections were health care-associated (p < 0.001). Furthermore, when compared to non-staphylococcal infections, the S. aureus group had more indwelling intravascular foreign material (p < 0.001), more rapid clinical progression (p < 0.001), and overall worse clinical presentation (p < 0.001). However, after stratifying by clinical presentation, the mortality rates in the 2 groups were similar (p = 0.45).Since approximately one-fifth of all CIED-related infections are caused by non-staphylococcal organisms, and untimely antibiotic treatment can result in serious complications, it may be prudent to broaden empiric antimicrobial therapy to cover both Gram-positive and -negative bacteria, until the causative organism is identified.
authors.affiliation: From the Division of Infectious Diseases (GMV), Department of Medicine, University of Texas M. D. Anderson Cancer Center; Baylor College of Medicine (GMV, LLA, ROD); University of Texas Medical School (LOZ); Michael E. DeBakey Veterans Affairs Medical Center (ROD); and Division of Biostatistics (WC), University of Texas Health Science Center; Houston, Texas.
authors.forename: George M
authors.initials: GM
authors.lastname: Viola
authors.forename: Leah L
authors.initials: LL
authors.lastname: Awan
authors.forename: Luis
authors.initials: L
authors.lastname: Ostrosky-Zeichner
authors.forename: Wenyaw
authors.initials: W
authors.lastname: Chan
authors.forename: Rabih O
authors.initials: RO
authors.lastname: Darouiche
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D001145:Arrhythmias, Cardiac / Q000628:therapy*; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D015897:Comorbidity; D017147:Defibrillators, Implantable / Q000009:adverse effects* / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial / Q000009:adverse effects* / Q000382:microbiology; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology*; D013211:Staphylococcus aureus / Q000302:isolation & purification*
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents