Staphylococcus bacteremia without evidence of cardiac implantable electronic device infection

Heart Rhythm. 2021 May;18(5):752-759. doi: 10.1016/j.hrthm.2020.12.011. Epub 2020 Dec 13.

Abstract

Background: Staphylococcus bacteremia (SB) in the presence of a cardiac implantable electronic device (CIED) is frequently associated with CIED infection. In patients without clear CIED infection but SB, the role of empirical CIED removal is unclear.

Objective: The purpose of this study was to describe the natural history of SB in the setting of a CIED and the effect of CIED removal on mortality in patients with concurrent SB without evidence of CIED infection.

Methods: Three hundred sixty consecutive patients (mean age 61 ± 17 years; 255 (71%) men; 329 (92%) Staphylococcus aureus) with a CIED and concurrent SB were reviewed.

Results: At the initial presentation with SB, 178 patients had no evidence of CIED infection. Of these, 132 (74%) had another identified source of infection. Among the 178 patients without CIED infection, 18 (10%) had empirical CIED removal during the initial bacteremia. Among those who did not undergo CIED removal, SB subsequently relapsed in 19% and relapse rates were not different for those with or without another identifiable source at the initial presentation. Relapse was strongly associated with the duration of SB >1 day (odds ratio 9.99; 95% confidence interval 3.24-30.86). Despite the absence of CIED infection, 1-year mortality was 35% and empirical device removal during the initial presentation was associated with survival benefit (hazard ratio 0.28; 95% confidence interval 0.08-0.95).

Conclusion: For patients with SB without evidence of CIED infection, relapse is predicted by the duration of bacteremia. Empirical CIED removal appears to be associated with a survival benefit, although there are likely clinical situations in which this could be deferred.

Keywords: Bacteremia; Cardiac implantable electronic device; Coagulase-negative staphylococci; Device removal; Staphylococcus aureus.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Arrhythmias, Cardiac / therapy*
  • Bacteremia / etiology*
  • Bacteremia / microbiology
  • Device Removal / methods
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pacemaker, Artificial / adverse effects*
  • Retrospective Studies
  • Risk Factors
  • Staphylococcal Infections / etiology*
  • Staphylococcal Infections / microbiology
  • Staphylococcus aureus / isolation & purification*