title: Predicting risk of endovascular device infection in patients with Staphylococcus aureus bacteremia (PREDICT-SAB).
abstract: BACKGROUND
  Prompt recognition of underlying cardiovascular implantable electronic device (CIED) infection in patients presenting with Staphylococcus aureus bacteremia (SAB) is critical for optimal management of these cases. The goal of this study was to identify clinical predictors of CIED infection in patients presenting with SAB and no signs of pocket infection.
  
  
  RESULTS
  All cases of SAB in CIED recipients at Mayo Clinic from 2001 to 2011 were retrospectively reviewed. We identified 131 patients with CIED who presented with SAB and had no clinical signs of device pocket infection. Forty-five (34%) of these patients had underlying CIED infection based on clinical or echocardiographic criteria. The presence of a permanent pacemaker rather than an implantable cardioverter-defibrillator (odds ratio, 3.90; 95% confidence interval, 1.65-9.23; P=0.002), >1 device-related procedure (odds ratio, 3.30; 95% confidence interval, 1.23-8.86; P=0.018), and duration of SAB ≥4 days (odds ratio, 5.54; 95% confidence interval, 3.32-13.23; P<0.001) were independently associated with an increased risk of CIED infection in a multivariable model. The area under the receiver operating characteristics curve for the multivariable model was 0.79, indicating a good discriminatory capacity to distinguish SAB patients with and without CIED infection.
  
  
  CONCLUSIONS
  Among patients presenting with SAB and no signs of pocket infection, the risk of underlying CIED infection can be calculated based on the type of device, number of device-related procedures, and duration of SAB. We propose that patients without any of these high-risk features have a low risk of underlying CIED infection and may be monitored closely without immediate device extraction. Prospective studies are needed to validate this risk prediction model.
authors.affiliation: From the Division of Infectious Diseases, Department of Medicine (M.R.S., B.R.P., S.K.,W.R.W., J.M.S, L.M.B.), Division of Cardiovascular Diseases, Department of Medicine (M.R.S., P.A.F., D.L.H., L.M.B.), Department of Biostatistics and Informatics (C.M.L.), Mayo Clinic College of Medicine, Rochester, MN; Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles (D.Z.U.); and Department of Medicine, University of Florida Health Science Center, Jacksonville (F.A.-S.). sohail.muhammad@mayo.edu.
authors.forename: M Rizwan
authors.initials: MR
authors.lastname: Sohail
authors.affiliation: From the Division of Infectious Diseases, Department of Medicine (M.R.S., B.R.P., S.K.,W.R.W., J.M.S, L.M.B.), Division of Cardiovascular Diseases, Department of Medicine (M.R.S., P.A.F., D.L.H., L.M.B.), Department of Biostatistics and Informatics (C.M.L.), Mayo Clinic College of Medicine, Rochester, MN; Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles (D.Z.U.); and Department of Medicine, University of Florida Health Science Center, Jacksonville (F.A.-S.).
authors.forename: Bharath Raj
authors.initials: BR
authors.lastname: Palraj
authors.affiliation: From the Division of Infectious Diseases, Department of Medicine (M.R.S., B.R.P., S.K.,W.R.W., J.M.S, L.M.B.), Division of Cardiovascular Diseases, Department of Medicine (M.R.S., P.A.F., D.L.H., L.M.B.), Department of Biostatistics and Informatics (C.M.L.), Mayo Clinic College of Medicine, Rochester, MN; Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles (D.Z.U.); and Department of Medicine, University of Florida Health Science Center, Jacksonville (F.A.-S.).
authors.forename: Sana
authors.initials: S
authors.lastname: Khalid
authors.affiliation: From the Division of Infectious Diseases, Department of Medicine (M.R.S., B.R.P., S.K.,W.R.W., J.M.S, L.M.B.), Division of Cardiovascular Diseases, Department of Medicine (M.R.S., P.A.F., D.L.H., L.M.B.), Department of Biostatistics and Informatics (C.M.L.), Mayo Clinic College of Medicine, Rochester, MN; Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles (D.Z.U.); and Department of Medicine, University of Florida Health Science Center, Jacksonville (F.A.-S.).
authors.forename: Daniel Z
authors.initials: DZ
authors.lastname: Uslan
authors.affiliation: From the Division of Infectious Diseases, Department of Medicine (M.R.S., B.R.P., S.K.,W.R.W., J.M.S, L.M.B.), Division of Cardiovascular Diseases, Department of Medicine (M.R.S., P.A.F., D.L.H., L.M.B.), Department of Biostatistics and Informatics (C.M.L.), Mayo Clinic College of Medicine, Rochester, MN; Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles (D.Z.U.); and Department of Medicine, University of Florida Health Science Center, Jacksonville (F.A.-S.).
authors.forename: Farah
authors.initials: F
authors.lastname: Al-Saffar
authors.affiliation: From the Division of Infectious Diseases, Department of Medicine (M.R.S., B.R.P., S.K.,W.R.W., J.M.S, L.M.B.), Division of Cardiovascular Diseases, Department of Medicine (M.R.S., P.A.F., D.L.H., L.M.B.), Department of Biostatistics and Informatics (C.M.L.), Mayo Clinic College of Medicine, Rochester, MN; Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles (D.Z.U.); and Department of Medicine, University of Florida Health Science Center, Jacksonville (F.A.-S.).
authors.forename: Paul A
authors.initials: PA
authors.lastname: Friedman
authors.affiliation: From the Division of Infectious Diseases, Department of Medicine (M.R.S., B.R.P., S.K.,W.R.W., J.M.S, L.M.B.), Division of Cardiovascular Diseases, Department of Medicine (M.R.S., P.A.F., D.L.H., L.M.B.), Department of Biostatistics and Informatics (C.M.L.), Mayo Clinic College of Medicine, Rochester, MN; Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles (D.Z.U.); and Department of Medicine, University of Florida Health Science Center, Jacksonville (F.A.-S.).
authors.forename: David L
authors.initials: DL
authors.lastname: Hayes
authors.affiliation: From the Division of Infectious Diseases, Department of Medicine (M.R.S., B.R.P., S.K.,W.R.W., J.M.S, L.M.B.), Division of Cardiovascular Diseases, Department of Medicine (M.R.S., P.A.F., D.L.H., L.M.B.), Department of Biostatistics and Informatics (C.M.L.), Mayo Clinic College of Medicine, Rochester, MN; Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles (D.Z.U.); and Department of Medicine, University of Florida Health Science Center, Jacksonville (F.A.-S.).
authors.forename: Christine M
authors.initials: CM
authors.lastname: Lohse
authors.affiliation: From the Division of Infectious Diseases, Department of Medicine (M.R.S., B.R.P., S.K.,W.R.W., J.M.S, L.M.B.), Division of Cardiovascular Diseases, Department of Medicine (M.R.S., P.A.F., D.L.H., L.M.B.), Department of Biostatistics and Informatics (C.M.L.), Mayo Clinic College of Medicine, Rochester, MN; Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles (D.Z.U.); and Department of Medicine, University of Florida Health Science Center, Jacksonville (F.A.-S.).
authors.forename: Walter R
authors.initials: WR
authors.lastname: Wilson
authors.affiliation: From the Division of Infectious Diseases, Department of Medicine (M.R.S., B.R.P., S.K.,W.R.W., J.M.S, L.M.B.), Division of Cardiovascular Diseases, Department of Medicine (M.R.S., P.A.F., D.L.H., L.M.B.), Department of Biostatistics and Informatics (C.M.L.), Mayo Clinic College of Medicine, Rochester, MN; Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles (D.Z.U.); and Department of Medicine, University of Florida Health Science Center, Jacksonville (F.A.-S.).
authors.forename: James M
authors.initials: JM
authors.lastname: Steckelberg
authors.affiliation: From the Division of Infectious Diseases, Department of Medicine (M.R.S., B.R.P., S.K.,W.R.W., J.M.S, L.M.B.), Division of Cardiovascular Diseases, Department of Medicine (M.R.S., P.A.F., D.L.H., L.M.B.), Department of Biostatistics and Informatics (C.M.L.), Mayo Clinic College of Medicine, Rochester, MN; Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles (D.Z.U.); and Department of Medicine, University of Florida Health Science Center, Jacksonville (F.A.-S.).
authors.forename: Larry M
authors.initials: LM
authors.lastname: Baddour
mesh_terms: D019540:Area Under Curve; D016470:Bacteremia / Q000175:diagnosis / Q000382:microbiology* / Q000401:mortality; D003661:Decision Support Techniques; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D006801:Humans; D016015:Logistic Models; D008910:Minnesota; D015999:Multivariate Analysis; D016017:Odds Ratio; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D011379:Prognosis; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000382:microbiology* / Q000401:mortality / Q000628:therapy; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000150:complications / Q000175:diagnosis / Q000382:microbiology* / Q000401:mortality; D013211:Staphylococcus aureus / Q000472:pathogenicity*; D013997:Time Factors
keywords: Staphylococcus aureus; bacteremia; defibrillators, implantable; endocarditis; infection; pacemaker