title: Microbial diagnosis of infection and colonization of cardiac implantable electronic devices by use of sonication.
abstract: OBJECTIVE
  The clinical utility of sonication as an adjunctive diagnostic tool for the microbial diagnosis of cardiac implantable device-associated infections (CIDAIs) was investigated.
  
  
  METHODS
  The implants of 83 subjects were investigated, 15 with a CIDAI and 68 without a clinical infection. Clinical data were analyzed prospectively and sonication fluid cultures (83 patients, 100%) and traditional cultures (31 patients, 37.4%) were performed
  
  
  RESULTS
  Generator pocket infection and device-related endocarditis were found in 13 (86.7%) and four (26.7%) subjects, respectively. The mean numbers of previous technical complications and infections were higher in the infected patients compared to the non-infected patients (8 vs. 1, p<0.001; 2 vs. 0, p<0.031, respectively). The sensitivity and specificity for detecting CIDAI was 73.3% (11/15) and 48.5% (33/68) for sonication fluid culture, and 26.7% (4/15) and 100% (16/16) for traditional culture (p<0.001), respectively. A higher number of organisms were identified by sonication fluid than by tissue culture (58 vs. 4 specimens; p<0.001). The most frequent organisms cultured were Gram-positive cocci (66.1%), mainly coagulase-negative staphylococci (35.5%). Thirty-five (51.5%) non-infected subjects were considered colonized due to the positive identification of organisms exclusively through sonication fluid culture.
  
  
  CONCLUSIONS
  Sonication fluid culture from the removed cardiac implants has the potential to improve the microbiological diagnosis of CIDAIs.
authors.affiliation: Emergency Service, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil.
authors.forename: Ricardo Cantarim
authors.initials: RC
authors.lastname: Inacio
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, Santa Casa de São Paulo School of Medical Sciences, Rua Dr Cesáreo Mota Jr 112, CEP 01303-060, São Paulo, SP, Brazil.
authors.forename: Giselle Burlamaqui
authors.initials: GB
authors.lastname: Klautau
authors.affiliation: Department of Laboratory Medicine and Pathology, Division of Infectious Diseases, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil.
authors.forename: Maria Aparecida S
authors.initials: MA
authors.lastname: Murça
authors.affiliation: Department of Laboratory Medicine and Pathology, Division of Infectious Diseases, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil.
authors.forename: Cely Barreto
authors.initials: CB
authors.lastname: da Silva
authors.affiliation: Department of Laboratory Medicine and Pathology, Division of Infectious Diseases, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil.
authors.forename: Stanley
authors.initials: S
authors.lastname: Nigro
authors.affiliation: Department of Surgery, Division of Infectious Diseases, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil.
authors.forename: Luiz Antonio
authors.initials: LA
authors.lastname: Rivetti
authors.affiliation: Department of Surgery, Division of Infectious Diseases, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil.
authors.forename: Wilson Lopes
authors.initials: WL
authors.lastname: Pereira
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, Santa Casa de São Paulo School of Medical Sciences, Rua Dr Cesáreo Mota Jr 112, CEP 01303-060, São Paulo, SP, Brazil. Electronic address: mcsalles@osite.com.br.
authors.forename: Mauro Jose Costa
authors.initials: MJ
authors.lastname: Salles
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017147:Defibrillators, Implantable / Q000382:microbiology*; D004697:Endocarditis, Bacterial / Q000175:diagnosis* / Q000382:microbiology; D005260:Female; D006095:Gram-Positive Cocci / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000382:microbiology*; D016459:Prosthesis-Related Infections / Q000175:diagnosis* / Q000382:microbiology; D012680:Sensitivity and Specificity; D013010:Sonication; D013210:Staphylococcus / Q000302:isolation & purification
keywords: Biofilm; Cardiac implantable electronic devices; Colonization; Infection; Sonication