Abstract 2490: Cardiovascular Implantable Electronic Device Infection in Patients With Non-Staphylococcus aureus Gram-Positive Coccal Bacteremia
Introduction: Infection is a serious complication of cardiac implantable electronic device (CIED) placement and requires device removal for attempted cure. The infection rate of and risk factors associated with cardiovascular implantable electronic device infection (CIEDI) in patients with gram-positive coccal (GPC) bacteremia excluding that due to Staphylococcus aureus have not been well studied.
Methods: We retrospectively identified 74 consecutive patients with a permanent pacemaker or implantable cardioverter-defibrillator and non-S. aureus GPC bacteremia between 2001 and 2007. CIEDI was defined as presence of signs of infection at a generator site, lead vegetations on echocardiography or microbiological growth from device cultures.
Results: CIEDI was present in 22 (30%) patients with bacteremia. The majority (n=18, 81%) of CIEDI occurred greater than 3 months after device implantation or manipulation. Risk factors associated with CIEDI are summarized in the table⇓. The number of leads was associated with CIEDI (p=0.03). The rate of CIEDI in patients with coagulase-negative staphylococcal (CoNS) bacteremia was almost two-fold that of non-CoNS bacteremia (36% vs 20%, p=0.13). Community-acquired CoNS bacteremia was associated with a higher rate of CIEDI compared to health care-associated and nosocomial bacteremias combined (67% vs 25%, p=0.005). Among 44 patients without identifiable CIEDI who did not undergo device removal, 5 experienced relapse of bacteremia within 12 weeks of completing antibiotic therapy. CoNS accounted for all relapses (relapse rate =23%).
Conclusion: CIEDI occurred in 30% of patients with non-S. aureus GPC bacteremia. A higher number of implanted leads was associated with a greater risk of CIEDI. Although the rate of CIEDI due CoNS bacteremia was not statistically significantly higher than that due to non-CoNS bacteremia, the almost 2-fold difference is likely clinically relevant and warrants further study.