Abstract
Introduction
Infections associated with cardiac implantable electronic devices (CIEDs) are a multifactorial disease that leads to increased morbidity and mortality.
Objective
The aim was to analyze patient-, disease- and treatment-related characteristics including microbiological and bacterial spectrum according to survival status and to identify risk factors for 1- and 3-year mortality in patients with local and systemic CIED infection.
Methods
In a retrospective cohort study, we analyzed data from patients with CIED-related local or systemic infection undergoing successful transvenous lead extraction (TLE). Survival status as well as incidence and cause of rehospitalization were recorded. Microbiology and antibiotics used as first-line therapy were compared according to mortality. Independent risk factors for 1- and 3-year mortality were determined.
Results
Data from 243 Patients were analyzed. In-hospital mortality was 2.5%. Mortality rates at 30 days, 1- and 3 years were 4.1%, 18.1% and 30%, respectively. Seventy-four (30.5%) patients had systemic bacterial infection. Independent risk factors for 1-year mortality included age (OR 1.05 [1.01–1.10], p = 0.014), NT-proBNP at admission (OR 4.18 [1.81–9.65], p = 0.001), new onset or worsened tricuspid regurgitation after TLE (OR 6.04 [1.58–23.02], p = 0.009), and systemic infection (OR 2.76 [1.08–7.03], p = 0.034), whereas systemic infection was no longer an independent risk factor for 3-year mortality. Staphylococcus aureus was found in 18.1% of patients who survived and in 25% of those who died, p = 0.092. There was a high proportion of methicillin-resistant strains among coagulase-negative staphylococci (16.5%) compared to Staphylococcus aureus (1.2%).
Conclusions
Staphylococci are the most common causative germs of CIED-infection with coagulase-negative staphylococci showing higher resistance rates to antibiotics. The independent risk factors for increased long-term mortality could contribute to individual risk stratification and well-founded treatment decisions in clinical routine. Especially the role of tricuspid regurgitation as a complication after TLE should be investigated in future studies.
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Data availability
The data underlying this article will be shared on reasonable request to the corresponding author.
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Appendix
Appendix
Laboratory results according to 1-year mortality
Survived n = 199 | Died n = 44 | p-Value | |
|---|---|---|---|
At admission | |||
Haemoglobin [mmol/L] | 7.9 (7.2–8.8) | 7.4 (6.2–8.3) | 0.009 |
Thrombocytes [103/µL] | 221 (169–273) | 204 (142–263) | 0.209 |
Leukocytes [Gpt/L] | 8.1 (6.7–10.0) | 8.2 (6.8–11.9) | 0.301 |
CRP [mg/L] | 9.0 (3.0–33.9) | 37.2 (10.1–99.8) | < 0.001 |
NT-proBNP [pg/mL] | 1109 (356–3425) | 3803 (1254–9063) | < 0.001 |
Creatinine [µmol/L] | 96 (79.0–131.0) | 112.5 (73.0–178.0) | 0.136 |
eGFR [mL/min/1.73] | 66 (48–89) | 54 (32–84) | 0.040 |
At discharge | |||
Haemoglobin [mmol/L] | 6.6 (6.0–7.4) | 6.4 (5.6–7.1) | 0.063 |
Thrombocytes [103/µL] | 215 (166–281) | 209 (142–306) | 0.734 |
Leukocytes [Gpt/L] | 7.2 (6.0–9.1) | 8.7 (7.1–11.4) | 0.003 |
CRP [mg/L] | 26.4 (13.3–59.0) | 49.7 (18.5–76.1) | 0.018 |
Creatinine [µmol/L] | 92 (75–134) | 130 (88–190) | 0.004 |
eGFR [mL/min/1.73] | 69 (46–86) | 46 (28–77) | 0.003 |
Difference in laboratory results from admission to discharge | |||
△Haemoglobin [mmol/L] | 1.2 (0.6–1.8) | 1 (0.45–1.55) | 0.160 |
△ Thrombocytes [103/µL] | −7 (−46–43) | 15 (−37–63) | 0.421 |
△Leukocytes [Gpt/L] | 0.7 (−0.5–2.1) | 0 (−1.7–2.0) | 0.136 |
△CRP [mg/L] | −11.2 (−29.8–5.8) | 1.3 (−17.5–26.8) | 0.013 |
△eGFR [mL/min/1.73] | 0.0 (−9.0–6.0) | 1 (−8–14) | 0.360 |
△Creatinine [µmol/L] | 4.0 (−9.0–17) | −1.0 (−38.5–17.5) | 0.180 |
Antibiotics used as first-line therapy according to 1-year mortality
Survived n = 199 | Died n = 44 | p-Value | |
|---|---|---|---|
Flucloxacillin | 39 (19.6%) | 9 (20.5%) | 0.897 |
Amoxicillin | 2 (1.0%) | 1 (2.3%) | 0.491 |
Ampicillin/sulbactam | 16 (8.0%) | 3 (6.8%) | 0.785 |
Piperacillin/tazobactam | 11 (5.5%) | 4 (9.1%) | 0.374 |
Cefuroxime | 50 (25.1%) | 7 (15.9%) | 0.192 |
Ceftriaxone | 2 (1.0%) | 3 (6.8%) | 0.014 |
Meropenem | 6 (3.0%) | 4 (9.1%) | 0.066 |
Ciprofloxacin | 7 (3.5%) | 1 (2.3%) | 0.675 |
Vancomycin | 36 (18.1%) | 12 (27.3%) | 0.166 |
Gentamicin | 13 (6.5%) | 4 (9.1%) | 0.547 |
Clindamycin | 27 (13.6%) | 3 (6.8%) | 0.218 |
Linezolid | 4 (2.0%) | 1 (2.3%) | 0.912 |
Daptomycin | 5 (2.5%) | 3 (6.8%) | 0.147 |
Rifampicin | 16 (8.0%) | 5 (11.4%) | 0.478 |
Cotrimoxazole | 3 (1.5%) | 0 (0%) | 0.412 |
Mortality table
Interval [days] | Number of patients entering Interval | Number of deaths | Cumulative proportion surviving at end of interval |
|---|---|---|---|
0 | 243 | 16 | 0.93 |
50 | 227 | 8 | 0.90 |
100 | 218 | 3 | 0.89 |
150 | 215 | 4 | 0.87 |
200 | 211 | 3 | 0.86 |
250 | 208 | 5 | 0.84 |
300 | 203 | 1 | 0.84 |
350 | 202 | 4 | 0.82 |
400 | 198 | 6 | 0.79 |
450 | 191 | 4 | 0.78 |
500 | 187 | 0 | 0.78 |
550 | 187 | 2 | 0.77 |
600 | 185 | 1 | 0.76 |
650 | 184 | 0 | 0.76 |
700 | 184 | 2 | 0.76 |
750 | 182 | 1 | 0.75 |
800 | 181 | 0 | 0.75 |
850 | 181 | 1 | 0.75 |
900 | 180 | 1 | 0.74 |
950 | 179 | 4 | 0.73 |
1000 | 175 | 2 | 0.72 |
1050 | 172 | 5 | 0.70 |
1100 | 164 | 0 | 0.70 |
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Schipmann, L.C., Moeller, V., Krimnitz, J. et al. Outcome and microbiological findings of patients with cardiac implantable electronic device infection. Heart Vessels (2024). https://doi.org/10.1007/s00380-024-02380-y
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DOI: https://doi.org/10.1007/s00380-024-02380-y