Outcomes in Patients With Cardiovascular Implantable Electronic Device Infection Managed With Chronic Antibiotic Suppression.
Most cardiovascular implantable electronic device (CIED) recipients are elderly, have multiple comorbid conditions, and are at increased risk of CIED infection (CIEDI). Current guidelines recommend complete device removal in patients with CIEDI to prevent relapse and mortality. However, comorbidities or other factors may preclude device removal, thus prompting a nonsurgical approach that includes chronic antibiotic suppression (CAS). There are limited data on outcomes of patients receiving CAS for CIEDI.
We retrospectively screened 660 CIEDI cases from 2005 to 2015 using electronic health records and a CIEDI institutional database and identified 48 patients prescribed CAS. Primary outcomes were infection relapse and survival.
The median age was 78 years, and 73% (35/48) were male. The median Charlson comorbidity index was 4. Common pathogens were coagulase-negative staphylococci (21%, 10/48) and methicillin-sensitive Staphylococcus aureus (19%, 9/48). At 1 month after hospitalization, 25% (12/48) of patients had died, of whom only 1 initiated CAS; 67% (8/12) of these had staphylococcal infections. Of the 37 patients who initiated CAS, the most common antimicrobials were trimethoprim-sulfamethoxazole, penicillin, and amoxicillin (22%, 8/37 each). Estimated median overall survival was 1.43 years (95% confidence interval, 0.27-2.14), with 18% (6/33 survivors) developing relapse within 1 year. Of the 6 patients who relapsed, 2 (33%) subsequently underwent CIED extraction.
CAS is reasonable in select patients who are not candidates for complete device removal for attempted cure of CIEDI. Nevertheless, 1-month mortality in our sample of CAS-eligible patients was high and reflective of high rates of comorbid conditions.
Division of Infectious Diseases, Department of Internal Medicine and.
Eugene M
EM
Tan
Division of Infectious Diseases, Department of Internal Medicine and.
Daniel C
DC
DeSimone
Division of Infectious Diseases, Department of Internal Medicine and.|Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
M Rizwan
MR
Sohail
Division of Infectious Diseases, Department of Internal Medicine and.|Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
Larry M
LM
Baddour
Division of Infectious Diseases, Department of Internal Medicine and.
Walter R
WR
Wilson
Division of Infectious Diseases, Department of Internal Medicine and.
James M
JM
Steckelberg
Division of Infectious Diseases, Department of Internal Medicine and.
Abinash
A
Virk
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D015897:Comorbidity; D020878:Device Removal; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000382:microbiology*; D016459:Prosthesis-Related Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000188:drug therapy; D013211:Staphylococcus aureus / Q000302:isolation & purification; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination
antibiotic; cardiovascular; device; suppression.