Cardiovascular implantable electronic device infection in patients with staphylococcus aureus bacteremia

Daniel Z. Uslan, Taylor F. Dowsley, Muhammad R. Sohail, David L. Hayes, Paul Andrew Friedman, Walter R. Wilson, James M. Steckelberg, Larry M. Baddour

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

Background: Staphylococcus aureus bacteremia (SAB) in patients with cardiovascular implantable electronic devices (CIED), including permanent pacemakers (PPMs) and implantable cardioverter-defibrillators (ICD), can be the sole manifestation of device infection. Methods: To assess clinical factors associated with CIED infection, we retrospectively reviewed all patients with both CIED and SAB seen at Mayo Clinic Rochester between 2001 through 2006. CIED infection was defined using microbiological and clinical criteria. Results: Of the 62 patients with SAB and a CIED, 22 patients (35.5%) had CIED infection. The generator pocket was identified as the source of bacteremia in seven (11%) patients. The majority of CIED infections were device-related infective endocarditis (12 of 22, 55%). Thirty percent of patients presenting with SAB greater than 1 year after device implantation had CIED infection; all but one had CIED-related infective endocarditis. Sixty percent of ICD patients (12 of 20) with SAB had CIED infection, compared with 24% of PPM patients (10 of 42, P = 0.01). On univariate analysis factors associated with CIED-related infective endocarditis included device type [odds ratio (OR) for ICD 13.3, 95% confidence interval [CI] 2.1, 84.9) and presence of a prosthetic heart valve (OR 6.8 95% CI 1.1, 43.4). Conclusions: CIED infection is common in patients with SAB. The presence of an ICD and prosthetic heart valve were associated with CIED-related infective endocarditis. Subsequent work should focus on prospectively characterizing the subset of patients with CIED infection who present with SAB as the sole manifestation of their device infection. (PACE 2010; 407-413)

Original languageEnglish (US)
Pages (from-to)407-413
Number of pages7
JournalPACE - Pacing and Clinical Electrophysiology
Volume33
Issue number4
DOIs
StatePublished - Apr 2010

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Bacteremia
Staphylococcus aureus
Equipment and Supplies
Infection
Implantable Defibrillators
Endocarditis
Heart Valves
Odds Ratio
Confidence Intervals

Keywords

  • Bacteremia
  • Defibrillator
  • Endocarditis
  • Infection
  • Pacemaker
  • Staphylococcus

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Cardiovascular implantable electronic device infection in patients with staphylococcus aureus bacteremia. / Uslan, Daniel Z.; Dowsley, Taylor F.; Sohail, Muhammad R.; Hayes, David L.; Friedman, Paul Andrew; Wilson, Walter R.; Steckelberg, James M.; Baddour, Larry M.

In: PACE - Pacing and Clinical Electrophysiology, Vol. 33, No. 4, 04.2010, p. 407-413.

Research output: Contribution to journalArticle

Uslan, Daniel Z. ; Dowsley, Taylor F. ; Sohail, Muhammad R. ; Hayes, David L. ; Friedman, Paul Andrew ; Wilson, Walter R. ; Steckelberg, James M. ; Baddour, Larry M. / Cardiovascular implantable electronic device infection in patients with staphylococcus aureus bacteremia. In: PACE - Pacing and Clinical Electrophysiology. 2010 ; Vol. 33, No. 4. pp. 407-413.
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abstract = "Background: Staphylococcus aureus bacteremia (SAB) in patients with cardiovascular implantable electronic devices (CIED), including permanent pacemakers (PPMs) and implantable cardioverter-defibrillators (ICD), can be the sole manifestation of device infection. Methods: To assess clinical factors associated with CIED infection, we retrospectively reviewed all patients with both CIED and SAB seen at Mayo Clinic Rochester between 2001 through 2006. CIED infection was defined using microbiological and clinical criteria. Results: Of the 62 patients with SAB and a CIED, 22 patients (35.5{\%}) had CIED infection. The generator pocket was identified as the source of bacteremia in seven (11{\%}) patients. The majority of CIED infections were device-related infective endocarditis (12 of 22, 55{\%}). Thirty percent of patients presenting with SAB greater than 1 year after device implantation had CIED infection; all but one had CIED-related infective endocarditis. Sixty percent of ICD patients (12 of 20) with SAB had CIED infection, compared with 24{\%} of PPM patients (10 of 42, P = 0.01). On univariate analysis factors associated with CIED-related infective endocarditis included device type [odds ratio (OR) for ICD 13.3, 95{\%} confidence interval [CI] 2.1, 84.9) and presence of a prosthetic heart valve (OR 6.8 95{\%} CI 1.1, 43.4). Conclusions: CIED infection is common in patients with SAB. The presence of an ICD and prosthetic heart valve were associated with CIED-related infective endocarditis. Subsequent work should focus on prospectively characterizing the subset of patients with CIED infection who present with SAB as the sole manifestation of their device infection. (PACE 2010; 407-413)",
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AU - Friedman, Paul Andrew

AU - Wilson, Walter R.

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AB - Background: Staphylococcus aureus bacteremia (SAB) in patients with cardiovascular implantable electronic devices (CIED), including permanent pacemakers (PPMs) and implantable cardioverter-defibrillators (ICD), can be the sole manifestation of device infection. Methods: To assess clinical factors associated with CIED infection, we retrospectively reviewed all patients with both CIED and SAB seen at Mayo Clinic Rochester between 2001 through 2006. CIED infection was defined using microbiological and clinical criteria. Results: Of the 62 patients with SAB and a CIED, 22 patients (35.5%) had CIED infection. The generator pocket was identified as the source of bacteremia in seven (11%) patients. The majority of CIED infections were device-related infective endocarditis (12 of 22, 55%). Thirty percent of patients presenting with SAB greater than 1 year after device implantation had CIED infection; all but one had CIED-related infective endocarditis. Sixty percent of ICD patients (12 of 20) with SAB had CIED infection, compared with 24% of PPM patients (10 of 42, P = 0.01). On univariate analysis factors associated with CIED-related infective endocarditis included device type [odds ratio (OR) for ICD 13.3, 95% confidence interval [CI] 2.1, 84.9) and presence of a prosthetic heart valve (OR 6.8 95% CI 1.1, 43.4). Conclusions: CIED infection is common in patients with SAB. The presence of an ICD and prosthetic heart valve were associated with CIED-related infective endocarditis. Subsequent work should focus on prospectively characterizing the subset of patients with CIED infection who present with SAB as the sole manifestation of their device infection. (PACE 2010; 407-413)

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