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. 2021 Mar 5:126.
doi: 10.48101/ujms.v126.5653. eCollection 2021.

Staphylococcus aureus bacteremia and cardiac implantable electronic devices in a county hospital setting: a population-based retrospective cohort study

Sara Pichtchoulin  1 , Ingrid Selmeryd  2 , Elisabeth Freyhult  3 , Pär Hedberg  1   4 , Jonas Selmeryd  1   4
Affiliations

Staphylococcus aureus bacteremia and cardiac implantable electronic devices in a county hospital setting: a population-based retrospective cohort study

Sara Pichtchoulin et al. Ups J Med Sci. .

Abstract

Background: Due to a high incidence of cardiac implantable electronic device-associated infective endocarditis (CIED-IE) in cases of Staphylococcus aureus bacteremia (SAB) and high mortality with conservative management, guidelines advocate device removal in all subjects with SAB. We aimed to investigate the clinical course of SAB in patients with a CIED (SAB+CIED) in a Swedish county hospital setting and relate it to guideline recommendations.

Methods: All CIED carriers with SAB, excluding clinical pocket infections, in the County of Västmanland during 2010-2017 were reviewed retrospectively.

Results: There were 61 cases of SAB+CIED during the study period, and CIED-IE was diagnosed in 13/61 (21%) cases. In-hospital death occurred in 19/61 (31%) cases, 34/61 (56%) cases were discharged with CIED device retained, and 8/61 (13%) cases were discharged after device removal. Subjects dying during hospitalization were elderly and diseased. No events was seen if the CIED was removed. Among four discharged cases with conservatively managed CIED-IE one relapse occured. Among 30 cases discharged with retained CIED and no evidence of IE, 22/30 (73%) cases had an uneventful follow-up, whereas adverse events secondary to overlooked CIED-IE were likely in 1/30 (3%) cases and could not be definitely excluded in additionally 4/30 (13%) cases.

Conclusions: During the study period, management became more active and prognosis improved. The heterogeneity within the population of SAB+CIED suggests that a management strategy based on an individual risk/benefit analysis could be an alternative to mandatory device removal.

Keywords: Staphylococcus aureus; cardiac implantable electronic device; endocarditis; pacemaker.

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Conflict of interest statement

The authors have nothing to disclose.

Figures

Figure 1
Figure 1
The yearly incidence of hospitalization due to Staphylococcus aureus bacteremia in cardiac implantable electronic device carriers (SAB+CIED) in the County of Västmanland, Sweden.
Figure 2
Figure 2
Euler diagrams illustrating the distribution and overlapping of some background characteristics stratified by discharge and device removal status. Medians were used for dichotomization. The sizes of the outer black circles are proportional to the sizes of the subgroups. CIED: cardiac implantable electronic device; CCS: Charlson Comorbidity Score.
Figure 3
Figure 3
Outcomes stratified by discharge and device removal status. CIED: cardiac implantable electronic device; IE: infective endocarditis; SAB: Staphylococcus aureus bacteremia. 1) Echocardiography was not performed in 13 cases. 2) Echocardiography was not performed in six cases.
Figure 4
Figure 4
Trends in outcome and management during the study period. The probabilities of having an adverse event (a), having transesophageal echocardiography (TEE) performed (b), cardiac implantable electronic device (CIED) removal considered (c), and CIED removal performed (d), expressed as functions of the year of inclusion are illustrated by unadjusted logistic regression probability estimates. Individual measurements are indicated as circles. P-values were calculated by logistic regression for association with the year of inclusion.
See this image and copyright information in PMC

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