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. 2015 Feb;8(1):137-44.
doi: 10.1161/CIRCEP.114.002199. Epub 2014 Dec 12.

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

M Rizwan Sohail  1 , Bharath Raj Palraj  2 , Sana Khalid  2 , Daniel Z Uslan  2 , Farah Al-Saffar  2 , Paul A Friedman  2 , David L Hayes  2 , Christine M Lohse  2 , Walter R Wilson  2 , James M Steckelberg  2 , Larry M Baddour  2
Affiliations

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

M Rizwan Sohail et al. Circ Arrhythm Electrophysiol. 2015 Feb.

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.

Keywords: Staphylococcus aureus; bacteremia; defibrillators, implantable; endocarditis; infection; pacemaker.

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Conflict of interest statement

Conflict of Interest Disclosures: All others have none.

Figures

Figure 1
Figure 1
Overall survival with or without CIED infection
Figure 2
Figure 2
Risk scores and predicted probability of CIED infection Four points were assigned for permanent pacemaker, 3.5 points were assigned for >1 device-related procedure, and 5 points were assigned for duration of SAB ≥4 days.
See this image and copyright information in PMC

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