Clinical Presentation, Management, and Outcomes of Cardiovascular Implantable Electronic Device Infections Due to Gram-Negative Versus Gram-Positive Bacteria

Zerelda Esquer Garrigos, Merit P. George, Prakhar Vijayvargiya, Eugene M. Tan, Saira Farid, Omar M. Abu Saleh, Paul Andrew Friedman, James M. Steckelberg, Daniel C. DeSimone, Walter R. Wilson, Larry M. Baddour, M. Rizwan Sohail

Research output: Contribution to journalArticle

Abstract

Objective: To describe and compare the clinical presentation, management, and outcomes of cardiovascular implantable electronic device (CIED) infections due to gram-negative bacteria (GNB) and CIED infections due to gram-positive bacteria (GPB). Patients and Methods: We retrospectively reviewed all CIED infection cases at Mayo Clinic from January 1, 1992, through December 31, 2015. Cases were classified based on positive microbiology data from extracted devices or blood cultures. Results: Of the 623 CIED infections during the study period, 31 (5.0%) were caused by GNB and 323 (51.8%) by GPB. Patients in the GNB group were more likely to present with local inflammatory findings at the pocket site (90.3% vs 72.4%; P=.03). All patients with bacteremia due to GNB had concomitant pocket infection compared with those with GPB (100% vs 33.9%; P=.002). After extraction, 41.9% of patients in the GNB group were managed with oral antibiotics vs 2.4% in the GPB group (P<.001). There were no statistically significant differences in infection relapse/recurrence or 1-year survival rates between the 2 groups. Conclusion: Compared with CIED infections caused by GPB, those due to GNB are more likely to present with pocket infection. Device-related GNB bacteremia almost always originates from the generator pocket. After extraction, oral antibiotic drug therapy may be a reasonable option in select cases of pocket infections due to GNB. No difference in outcomes was observed between the 2 groups.

Original languageEnglish (US)
JournalMayo Clinic proceedings
DOIs
StatePublished - Jan 1 2019
Externally publishedYes

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Gram-Positive Bacteria
Gram-Negative Bacteria
Equipment and Supplies
Infection
Bacteremia
Anti-Bacterial Agents
Recurrence
Microbiology
Survival Rate
Drug Therapy

ASJC Scopus subject areas

  • Medicine(all)

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Clinical Presentation, Management, and Outcomes of Cardiovascular Implantable Electronic Device Infections Due to Gram-Negative Versus Gram-Positive Bacteria. / Esquer Garrigos, Zerelda; George, Merit P.; Vijayvargiya, Prakhar; Tan, Eugene M.; Farid, Saira; Abu Saleh, Omar M.; Friedman, Paul Andrew; Steckelberg, James M.; DeSimone, Daniel C.; Wilson, Walter R.; Baddour, Larry M.; Sohail, M. Rizwan.

In: Mayo Clinic proceedings, 01.01.2019.

Research output: Contribution to journalArticle

Esquer Garrigos, Z, George, MP, Vijayvargiya, P, Tan, EM, Farid, S, Abu Saleh, OM, Friedman, PA, Steckelberg, JM, DeSimone, DC, Wilson, WR, Baddour, LM & Sohail, MR 2019, 'Clinical Presentation, Management, and Outcomes of Cardiovascular Implantable Electronic Device Infections Due to Gram-Negative Versus Gram-Positive Bacteria', Mayo Clinic proceedings. https://doi.org/10.1016/j.mayocp.2018.11.029
Esquer Garrigos, Zerelda ; George, Merit P. ; Vijayvargiya, Prakhar ; Tan, Eugene M. ; Farid, Saira ; Abu Saleh, Omar M. ; Friedman, Paul Andrew ; Steckelberg, James M. ; DeSimone, Daniel C. ; Wilson, Walter R. ; Baddour, Larry M. ; Sohail, M. Rizwan. / Clinical Presentation, Management, and Outcomes of Cardiovascular Implantable Electronic Device Infections Due to Gram-Negative Versus Gram-Positive Bacteria. In: Mayo Clinic proceedings. 2019.
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abstract = "Objective: To describe and compare the clinical presentation, management, and outcomes of cardiovascular implantable electronic device (CIED) infections due to gram-negative bacteria (GNB) and CIED infections due to gram-positive bacteria (GPB). Patients and Methods: We retrospectively reviewed all CIED infection cases at Mayo Clinic from January 1, 1992, through December 31, 2015. Cases were classified based on positive microbiology data from extracted devices or blood cultures. Results: Of the 623 CIED infections during the study period, 31 (5.0{\%}) were caused by GNB and 323 (51.8{\%}) by GPB. Patients in the GNB group were more likely to present with local inflammatory findings at the pocket site (90.3{\%} vs 72.4{\%}; P=.03). All patients with bacteremia due to GNB had concomitant pocket infection compared with those with GPB (100{\%} vs 33.9{\%}; P=.002). After extraction, 41.9{\%} of patients in the GNB group were managed with oral antibiotics vs 2.4{\%} in the GPB group (P<.001). There were no statistically significant differences in infection relapse/recurrence or 1-year survival rates between the 2 groups. Conclusion: Compared with CIED infections caused by GPB, those due to GNB are more likely to present with pocket infection. Device-related GNB bacteremia almost always originates from the generator pocket. After extraction, oral antibiotic drug therapy may be a reasonable option in select cases of pocket infections due to GNB. No difference in outcomes was observed between the 2 groups.",
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AU - Esquer Garrigos, Zerelda

AU - George, Merit P.

AU - Vijayvargiya, Prakhar

AU - Tan, Eugene M.

AU - Farid, Saira

AU - Abu Saleh, Omar M.

AU - Friedman, Paul Andrew

AU - Steckelberg, James M.

AU - DeSimone, Daniel C.

AU - Wilson, Walter R.

AU - Baddour, Larry M.

AU - Sohail, M. Rizwan

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective: To describe and compare the clinical presentation, management, and outcomes of cardiovascular implantable electronic device (CIED) infections due to gram-negative bacteria (GNB) and CIED infections due to gram-positive bacteria (GPB). Patients and Methods: We retrospectively reviewed all CIED infection cases at Mayo Clinic from January 1, 1992, through December 31, 2015. Cases were classified based on positive microbiology data from extracted devices or blood cultures. Results: Of the 623 CIED infections during the study period, 31 (5.0%) were caused by GNB and 323 (51.8%) by GPB. Patients in the GNB group were more likely to present with local inflammatory findings at the pocket site (90.3% vs 72.4%; P=.03). All patients with bacteremia due to GNB had concomitant pocket infection compared with those with GPB (100% vs 33.9%; P=.002). After extraction, 41.9% of patients in the GNB group were managed with oral antibiotics vs 2.4% in the GPB group (P<.001). There were no statistically significant differences in infection relapse/recurrence or 1-year survival rates between the 2 groups. Conclusion: Compared with CIED infections caused by GPB, those due to GNB are more likely to present with pocket infection. Device-related GNB bacteremia almost always originates from the generator pocket. After extraction, oral antibiotic drug therapy may be a reasonable option in select cases of pocket infections due to GNB. No difference in outcomes was observed between the 2 groups.

AB - Objective: To describe and compare the clinical presentation, management, and outcomes of cardiovascular implantable electronic device (CIED) infections due to gram-negative bacteria (GNB) and CIED infections due to gram-positive bacteria (GPB). Patients and Methods: We retrospectively reviewed all CIED infection cases at Mayo Clinic from January 1, 1992, through December 31, 2015. Cases were classified based on positive microbiology data from extracted devices or blood cultures. Results: Of the 623 CIED infections during the study period, 31 (5.0%) were caused by GNB and 323 (51.8%) by GPB. Patients in the GNB group were more likely to present with local inflammatory findings at the pocket site (90.3% vs 72.4%; P=.03). All patients with bacteremia due to GNB had concomitant pocket infection compared with those with GPB (100% vs 33.9%; P=.002). After extraction, 41.9% of patients in the GNB group were managed with oral antibiotics vs 2.4% in the GPB group (P<.001). There were no statistically significant differences in infection relapse/recurrence or 1-year survival rates between the 2 groups. Conclusion: Compared with CIED infections caused by GPB, those due to GNB are more likely to present with pocket infection. Device-related GNB bacteremia almost always originates from the generator pocket. After extraction, oral antibiotic drug therapy may be a reasonable option in select cases of pocket infections due to GNB. No difference in outcomes was observed between the 2 groups.

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