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. 2021 Aug 21;3(9):488-496.
doi: 10.1253/circrep.CR-21-0095. eCollection 2021 Sep 10.

Temporal and Microbiological Analysis of Cardiac Implantable Electrical Device Infections - A Retrospective Study

Yasuo Miyagi  1 , Shun-Ichiro Sakamoto  1 , Yasuhiro Kawase  1 , Hiroya Oomori  1 , Yoshiyuki Watanabe  1 , Jiro Kurita  1 , Yuji Maruyama  1 , Takashi Sasaki  1 , Yosuke Ishii  1
Affiliations

Temporal and Microbiological Analysis of Cardiac Implantable Electrical Device Infections - A Retrospective Study

Yasuo Miyagi et al. Circ Rep. .

Abstract

Background: Although the causative pathogens in cardiac implantable electronic device (CIED) infections are well known, the relationship between time after implantation and infection patterns has not been sufficiently investigated. This study investigated the microbiology and onset of CIED infections according to infection patterns. Methods and Results: This retrospective study included 97 patients who underwent CIED removal due to device-related infections between April 2009 and December 2018. After device implantation, infections peaked in the first year and declined gradually over 10 years. Most infections (>60%) occurred within 5 years. Staphylococcal infections, the predominant form of CIED infections, occurred throughout the study period. CIED infections were categorized as systemic (SI; n=26) or local (LI; n=71) infections according to clinical presentation, and as CIED pocket-related (PR; n=85) and non-pocket-related (non-PR; n=12) infections according to the pathogenic pathway. The main causative pathogen in SI was Staphylococcus aureus, whereas coagulase-negative staphylococci were mainly related to LI. Both SI and LI peaked in the first year after implantation and then decreased gradually. There was no significant microbiological difference between PR and non-PR infections. PR infections showed the same temporal distribution as the overall cohort. However, non-PR infections exhibited a uniform temporal distribution after the first year. Conclusions: The severity of CIED infections depends on the causative pathogen, whereas their temporal distribution is affected by the microbiological intrusion pathway.

Keywords: Devices; Endocarditis; Infection.

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Conflict of interest statement

None declared.

Figures

Figure 1.
Figure 1.
Microbiology of 97 patients who underwent cardiac implantable electronic device removal/extraction for cardiac implantable electronic device (CIED)-related infections from 2009 to 2018. CoNS, coagulase-negative Staphylococcus; MRSA, methicillin-resistant Staphylococcus aureus; MSSA, methicillin-sensitive Staphylococcus aureus.
Figure 2.
Figure 2.
Temporal and microbiological distribution of cardiac implantable electronic device (CIED) infections. CoNS, coagulase-negative Staphylococcus; non-SP, non-staphylococcal species; S. aureus, Staphylococcus aureus.
Figure 3.
Figure 3.
Classification of patients with cardiac implantable electronic device (CIED) infections. CIED patients were classified as showing systemic infection (n=26) or local infection (n=71). CIED patients were also classified as having either pocket-related infections (n=85) or non-pocket-related infections (n=12).
Figure 4.
Figure 4.
Temporal and microbiological distribution: systemic infections vs. local infection. CoNS, coagulase-negative Staphylococcus; non-SP, non-staphylococcal species; S. aureus, Staphylococcus aureus.
Figure 5.
Figure 5.
Temporal and microbiological analysis according to pathogenic pathways. (A) pocket-related (PR) infections (n=12) vs. non-PR infections (n=85); (B) PR systemic infections (n=12) vs. non-pocket-related systemic infections (n=14); (C) PR systemic infections (n=14) vs. PR local infections (n=71). CoNS, coagulase-negative Staphylococcus; non-SP, non-staphylococcal species; S. aureus, Staphylococcus aureus.
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