Predicting risk of endovascular device infection in patients with staphylococcus aureus bacteremia (PREDICT-SAB)

M. Rizwan Sohail, Bharath Raj Palraj, Sana Khalid, Daniel Z. Uslan, Farah Al-Saffar, Paul Andrew Friedman, David L. Hayes, Christine M. Lohse, Walter R. Wilson, James M. Steckelberg, Larry M. Baddour

Research output: Contribution to journalArticle

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Abstract

Background - Prompt recognition of underlying cardiovascular implantable electronic device (CIED) infection in patients presenting with Staphylococcus aureus bacteremia (SAB) is critical for optimal management of these cases. The goal of this study was to identify clinical predictors of CIED infection in patients presenting with SAB and no signs of pocket infection. Methods and Results - All cases of SAB in CIED recipients at Mayo Clinic from 2001 to 2011 were retrospectively reviewed. We identified 131 patients with CIED who presented with SAB and had no clinical signs of device pocket infection. Forty-five (34%) of these patients had underlying CIED infection based on clinical or echocardiographic criteria. The presence of a permanent pacemaker rather than an implantable cardioverter-defibrillator (odds ratio, 3.90; 95% confidence interval, 1.65-9.23; P=0.002), >1 device-related procedure (odds ratio, 3.30; 95% confidence interval, 1.23-8.86; P=0.018), and duration of SAB ≥4 days (odds ratio, 5.54; 95% confidence interval, 3.32-13.23; P<0.001) were independently associated with an increased risk of CIED infection in a multivariable model. The area under the receiver operating characteristics curve for the multivariable model was 0.79, indicating a good discriminatory capacity to distinguish SAB patients with and without CIED infection. Conclusions - Among patients presenting with SAB and no signs of pocket infection, the risk of underlying CIED infection can be calculated based on the type of device, number of device-related procedures, and duration of SAB. We propose that patients without any of these high-risk features have a low risk of underlying CIED infection and may be monitored closely without immediate device extraction. Prospective studies are needed to validate this risk prediction model.

Original languageEnglish (US)
Pages (from-to)137-144
Number of pages8
JournalCirculation: Arrhythmia and Electrophysiology
Volume8
Issue number1
DOIs
StatePublished - Feb 28 2015

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Bacteremia
Staphylococcus aureus
Equipment and Supplies
Infection
Odds Ratio
Confidence Intervals
Implantable Defibrillators
Case Management
ROC Curve

Keywords

  • bacteremia
  • defibrillators, implantable
  • endocarditis
  • infection
  • pacemaker
  • Staphylococcus aureus

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Predicting risk of endovascular device infection in patients with staphylococcus aureus bacteremia (PREDICT-SAB). / Sohail, M. Rizwan; Palraj, Bharath Raj; Khalid, Sana; Uslan, Daniel Z.; Al-Saffar, Farah; Friedman, Paul Andrew; Hayes, David L.; Lohse, Christine M.; Wilson, Walter R.; Steckelberg, James M.; Baddour, Larry M.

In: Circulation: Arrhythmia and Electrophysiology, Vol. 8, No. 1, 28.02.2015, p. 137-144.

Research output: Contribution to journalArticle

Sohail, MR, Palraj, BR, Khalid, S, Uslan, DZ, Al-Saffar, F, Friedman, PA, Hayes, DL, Lohse, CM, Wilson, WR, Steckelberg, JM & Baddour, LM 2015, 'Predicting risk of endovascular device infection in patients with staphylococcus aureus bacteremia (PREDICT-SAB)', Circulation: Arrhythmia and Electrophysiology, vol. 8, no. 1, pp. 137-144. https://doi.org/10.1161/CIRCEP.114.002199
Sohail, M. Rizwan ; Palraj, Bharath Raj ; Khalid, Sana ; Uslan, Daniel Z. ; Al-Saffar, Farah ; Friedman, Paul Andrew ; Hayes, David L. ; Lohse, Christine M. ; Wilson, Walter R. ; Steckelberg, James M. ; Baddour, Larry M. / Predicting risk of endovascular device infection in patients with staphylococcus aureus bacteremia (PREDICT-SAB). In: Circulation: Arrhythmia and Electrophysiology. 2015 ; Vol. 8, No. 1. pp. 137-144.
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abstract = "Background - Prompt recognition of underlying cardiovascular implantable electronic device (CIED) infection in patients presenting with Staphylococcus aureus bacteremia (SAB) is critical for optimal management of these cases. The goal of this study was to identify clinical predictors of CIED infection in patients presenting with SAB and no signs of pocket infection. Methods and Results - All cases of SAB in CIED recipients at Mayo Clinic from 2001 to 2011 were retrospectively reviewed. We identified 131 patients with CIED who presented with SAB and had no clinical signs of device pocket infection. Forty-five (34{\%}) of these patients had underlying CIED infection based on clinical or echocardiographic criteria. The presence of a permanent pacemaker rather than an implantable cardioverter-defibrillator (odds ratio, 3.90; 95{\%} confidence interval, 1.65-9.23; P=0.002), >1 device-related procedure (odds ratio, 3.30; 95{\%} confidence interval, 1.23-8.86; P=0.018), and duration of SAB ≥4 days (odds ratio, 5.54; 95{\%} confidence interval, 3.32-13.23; P<0.001) were independently associated with an increased risk of CIED infection in a multivariable model. The area under the receiver operating characteristics curve for the multivariable model was 0.79, indicating a good discriminatory capacity to distinguish SAB patients with and without CIED infection. Conclusions - Among patients presenting with SAB and no signs of pocket infection, the risk of underlying CIED infection can be calculated based on the type of device, number of device-related procedures, and duration of SAB. We propose that patients without any of these high-risk features have a low risk of underlying CIED infection and may be monitored closely without immediate device extraction. Prospective studies are needed to validate this risk prediction model.",
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AU - Palraj, Bharath Raj

AU - Khalid, Sana

AU - Uslan, Daniel Z.

AU - Al-Saffar, Farah

AU - Friedman, Paul Andrew

AU - Hayes, David L.

AU - Lohse, Christine M.

AU - Wilson, Walter R.

AU - Steckelberg, James M.

AU - Baddour, Larry M.

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N2 - Background - Prompt recognition of underlying cardiovascular implantable electronic device (CIED) infection in patients presenting with Staphylococcus aureus bacteremia (SAB) is critical for optimal management of these cases. The goal of this study was to identify clinical predictors of CIED infection in patients presenting with SAB and no signs of pocket infection. Methods and Results - All cases of SAB in CIED recipients at Mayo Clinic from 2001 to 2011 were retrospectively reviewed. We identified 131 patients with CIED who presented with SAB and had no clinical signs of device pocket infection. Forty-five (34%) of these patients had underlying CIED infection based on clinical or echocardiographic criteria. The presence of a permanent pacemaker rather than an implantable cardioverter-defibrillator (odds ratio, 3.90; 95% confidence interval, 1.65-9.23; P=0.002), >1 device-related procedure (odds ratio, 3.30; 95% confidence interval, 1.23-8.86; P=0.018), and duration of SAB ≥4 days (odds ratio, 5.54; 95% confidence interval, 3.32-13.23; P<0.001) were independently associated with an increased risk of CIED infection in a multivariable model. The area under the receiver operating characteristics curve for the multivariable model was 0.79, indicating a good discriminatory capacity to distinguish SAB patients with and without CIED infection. Conclusions - Among patients presenting with SAB and no signs of pocket infection, the risk of underlying CIED infection can be calculated based on the type of device, number of device-related procedures, and duration of SAB. We propose that patients without any of these high-risk features have a low risk of underlying CIED infection and may be monitored closely without immediate device extraction. Prospective studies are needed to validate this risk prediction model.

AB - Background - Prompt recognition of underlying cardiovascular implantable electronic device (CIED) infection in patients presenting with Staphylococcus aureus bacteremia (SAB) is critical for optimal management of these cases. The goal of this study was to identify clinical predictors of CIED infection in patients presenting with SAB and no signs of pocket infection. Methods and Results - All cases of SAB in CIED recipients at Mayo Clinic from 2001 to 2011 were retrospectively reviewed. We identified 131 patients with CIED who presented with SAB and had no clinical signs of device pocket infection. Forty-five (34%) of these patients had underlying CIED infection based on clinical or echocardiographic criteria. The presence of a permanent pacemaker rather than an implantable cardioverter-defibrillator (odds ratio, 3.90; 95% confidence interval, 1.65-9.23; P=0.002), >1 device-related procedure (odds ratio, 3.30; 95% confidence interval, 1.23-8.86; P=0.018), and duration of SAB ≥4 days (odds ratio, 5.54; 95% confidence interval, 3.32-13.23; P<0.001) were independently associated with an increased risk of CIED infection in a multivariable model. The area under the receiver operating characteristics curve for the multivariable model was 0.79, indicating a good discriminatory capacity to distinguish SAB patients with and without CIED infection. Conclusions - Among patients presenting with SAB and no signs of pocket infection, the risk of underlying CIED infection can be calculated based on the type of device, number of device-related procedures, and duration of SAB. We propose that patients without any of these high-risk features have a low risk of underlying CIED infection and may be monitored closely without immediate device extraction. Prospective studies are needed to validate this risk prediction model.

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KW - defibrillators, implantable

KW - endocarditis

KW - infection

KW - pacemaker

KW - Staphylococcus aureus

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