Cardiovascular implantable electronic device infections due to enterococcal species: Clinical features, management, and outcomes.
Aged
Aged, 80 and over
Anti-Bacterial Agents
/ therapeutic use
Defibrillators, Implantable
/ microbiology
Echocardiography, Transesophageal
Endocarditis, Bacterial
/ diagnostic imaging
Enterococcus
/ isolation & purification
Female
Gram-Positive Bacterial Infections
/ diagnostic imaging
Humans
Male
Middle Aged
Pacemaker, Artificial
/ microbiology
Postoperative Complications
/ microbiology
Prospective Studies
Prosthesis-Related Infections
/ diagnostic imaging
Enterococcal infections
endocarditis
implantable cardioverter defibrillators
outcomes
pacemakers
Journal
Pacing and clinical electrophysiology : PACE
ISSN: 1540-8159
Titre abrégé: Pacing Clin Electrophysiol
Pays: United States
ID NLM: 7803944
Informations de publication
Date de publication:
10 2019
10 2019
Historique:
received:
29
05
2019
revised:
31
07
2019
accepted:
15
08
2019
pubmed:
20
8
2019
medline:
25
8
2020
entrez:
20
8
2019
Statut:
ppublish
Résumé
Enterococcal cardiovascular implantable electronic device (CIED) infections are not well characterized. Data from the Multicenter Electrophysiologic Device Infection Cohort, a prospective study of CIED infections, were used for descriptive analysis of adults with enterococcal CIED infections. Of 433 patients, 21 (4.8%) had enterococcal CIED infection. Median age was 71 years. Twelve patients (57%) had permanent pacemakers, five (24%) implantable cardioverter defibrillators, and four (19%) biventricular devices. Median time from last procedure to infection was 570 days. CIED-related bloodstream infections occurred in three patients (14%) and 18 (86%) had infective endocarditis (IE), 14 (78%) of which were definite by the modified Duke criteria. IE cases were classified as follows: valvular IE, four; lead IE, eight; both valve and lead IE, six. Vegetations were demonstrated by transesophageal echocardiography in 17 patients (81%). Blood cultures were positive in 19/19 patients with confirmed results. The most common antimicrobial regimen was penicillin plus an aminoglycoside (33%). Antibiotics were given for a median of 43 days. Only 14 patients (67%) underwent device removal. There was one death during the index hospitalization with four additional deaths within 6 months (overall mortality 24%). There were no relapses. Enterococci caused 4.8% of CIED infections in our cohort. Based on the late onset after device placement or manipulation, most infections were likely hematogenous in origin. IE was the most common infection syndrome. Only 67% of patients underwent device removal. At 6 months follow-up, no CIED infection relapses had occurred, but overall mortality was 24%.
Sections du résumé
BACKGROUND
Enterococcal cardiovascular implantable electronic device (CIED) infections are not well characterized.
METHODS
Data from the Multicenter Electrophysiologic Device Infection Cohort, a prospective study of CIED infections, were used for descriptive analysis of adults with enterococcal CIED infections.
RESULTS
Of 433 patients, 21 (4.8%) had enterococcal CIED infection. Median age was 71 years. Twelve patients (57%) had permanent pacemakers, five (24%) implantable cardioverter defibrillators, and four (19%) biventricular devices. Median time from last procedure to infection was 570 days. CIED-related bloodstream infections occurred in three patients (14%) and 18 (86%) had infective endocarditis (IE), 14 (78%) of which were definite by the modified Duke criteria. IE cases were classified as follows: valvular IE, four; lead IE, eight; both valve and lead IE, six. Vegetations were demonstrated by transesophageal echocardiography in 17 patients (81%). Blood cultures were positive in 19/19 patients with confirmed results. The most common antimicrobial regimen was penicillin plus an aminoglycoside (33%). Antibiotics were given for a median of 43 days. Only 14 patients (67%) underwent device removal. There was one death during the index hospitalization with four additional deaths within 6 months (overall mortality 24%). There were no relapses.
CONCLUSIONS
Enterococci caused 4.8% of CIED infections in our cohort. Based on the late onset after device placement or manipulation, most infections were likely hematogenous in origin. IE was the most common infection syndrome. Only 67% of patients underwent device removal. At 6 months follow-up, no CIED infection relapses had occurred, but overall mortality was 24%.
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Journal Article
Multicenter Study
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1331-1339Subventions
Organisme : American Heart Association-American Stroke Association
ID : 0835215N
Pays : United States
Informations de copyright
© 2019 Wiley Periodicals, Inc.
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