Predictors of bloodstream infection in patients presenting with cardiovascular implantable electronic device pocket infection

Zerelda Esquer Garrigos, Merit P. George, Sarwat Khalil, Prakhar Vijayvargiya, Omar M.Abu Saleh, Paul A. Friedman, James M. Steckelberg, Daniel C. DeSimone, Walter R. Wilson, Larry M. Baddour, M. Rizwan Sohail

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background. Generator pocket infection is the most frequent presentation of cardiovascular implantable electronic device (CIED) infection. We aim to identify predictors of underlying bloodstream infection (BSI) in patients presenting with CIED pocket infection. Methods. We retrospectively reviewed all adults with CIED pocket infection cared for at our institution from January 2005 through January 2016. The CIED pocket infection cases were then subclassified as with or without associated BSI. Variables with P values <.05 at univariate analysis were included in a multivariable model to identify independent predictors of underlying BSI. Results. We screened 429 cases of CIED infection, and 95 met the inclusion criteria. Of these, 68 cases (71.6%) were categorized as non-BSI and 27 (28.4%) as BSI. There were no statistically significant differences in patient comorbid conditions or device characteristics between the 2 groups. In multivariable analysis, the presence of systemic inflammatory response syndrome criteria (tachycardia, tachypnea, fever or hypothermia, and leukocytosis or leukopenia) and hypotension were independent predictors of underlying BSI in patients presenting with CIED pocket infection. Overall, patients in the non-BSI group who did not receive pre-extraction antibiotics had a higher frequency of positive intraoperative pocket/device cultures than those with pre-extraction antibiotic exposure (79.4% vs 58.6%; P = .06). Conclusions. Patients with CIED pocket infection who meet systemic inflammatory response syndrome criteria and/or are hypotensive at admission are more likely to have underlying BSI and should be started on empiric antibiotics after blood cultures are obtained. If these features are absent, it may be reasonable to withhold empiric antibiotics to optimize yield of pocket/device cultures during extraction.

Original languageEnglish (US)
Article numberofz084
JournalOpen Forum Infectious Diseases
Volume6
Issue number4
DOIs
StatePublished - Apr 2019

Keywords

  • bloodstream infection
  • cardiovascular implantable electronic device infections
  • generator-pocket infection
  • predictors
  • treatment

ASJC Scopus subject areas

  • Oncology
  • Clinical Neurology

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