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. 2024 Sep 9;11(9):ofae515.
doi: 10.1093/ofid/ofae515. eCollection 2024 Sep.

Incidence of Staphylococcus aureus Bacteremia in Patients Following Implantation of Cardiac Implantable Electronic Devices: A Danish Nationwide Cohort Study

Kasper Høtoft Bengtsen  1 , Alexander Christian Falkentoft  1 , Melanie Vuong Le  1 , Ketil Haugan  1 , Berit Thornvig Philbert  2 , Jens Brock Johansen  3 , Christian Torp-Pedersen  4 , Sam Riahi  5 , Jens Cosedis Nielsen  6 , Charlotte Larroudé  7 , Andreas Petersen  8 , Anders Rhod Larsen  8 , Lauge Østergaard  2 , Emil Fosbøl  2 , Niels Eske Bruun  1 , Anne-Christine Ruwald  1   2
Affiliations

Incidence of Staphylococcus aureus Bacteremia in Patients Following Implantation of Cardiac Implantable Electronic Devices: A Danish Nationwide Cohort Study

Kasper Høtoft Bengtsen et al. Open Forum Infect Dis. .

Abstract

Background: Staphylococcus aureus bacteremia (SAB) is a high-risk condition associated with high morbidity and mortality. In the presence of cardiac implantable electronic devices (CIEDs), SAB may cause or clinically indicate device infection. We aimed to estimate the 10-year absolute risk of SAB in adult Danish first-time CIED carriers. Secondary aims included identification of risk factors associated with SAB.

Methods: A registry-based study utilizing Danish nationwide registers and including consecutive Danish patients undergoing first CIED implantation between 2000 and 2020 was conducted. The primary outcome was first-time SAB after CIED implantation.

Results: A total of 87 257 patients with first CIED implantation in the study period were identified (median age, 75 years; 62.6% were male; median follow-up, 3.8 years). Patients with pacemakers (PMs) were older and with more noncardiovascular comorbidities compared to patients with implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy devices with or without defibrillator capacity (CRTs). In total, 1366 patients (1.6%) developed SAB. The 10-year absolute risk (95% confidence interval) of SAB was 2.0% (1.9%-2.1%) for PM, 2.6% (2.2%-3.1%) for ICD, and 3.7% (3.0%-4.5%) for CRT. A multivariable Cox analysis identified hemodialysis (hazard ratio [HR], 8.51), SAB before CIED (HR, 2.76), liver disease (HR, 2.35), and carrying a CRT device (HR, 1.68) among the covariates associated with increased risk of SAB.

Conclusions: The absolute risk of SAB in Danish CIED carriers increased with more advanced CIED systems. The risk was highest within the first 3 months after CIED implantation and increased with the presence of certain covariates including renal dialysis, SAB before CIED, male sex, and advancing age.

Keywords: CIED; Cardiac resynchronization therapy; Implantable cardioverter defibrillator; Pacemaker; Staphylococcus aureus bacteremia.

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Conflict of interest statement

Potential conflicts of interest. N. E. B. reports grants/contracts not related to this study from the Novo Nordisk Foundation and Health Insurance Denmark, and participation on a data and safety monitoring board or advisory board in the Heart Runner Project. E. F. reports grants/contracts not related to this study from the Novo Nordisk Foundation. J. B. J. reports payment or honoraria for lectures, presentations, speaker’s bureaus, manuscript writing, or educational events not related to this project from Medtonic and Merit Medical. J. C. N. reports a role as executive editor for Europace. S. R. reports grants/contracts not related to this study from the Novo Nordisk Foundation. A. C. R. reports payment or honoraria for lectures, presentations, speaker’s bureaus, manuscript writing, or educational events nor related to this project from Novartis, Bristol-Myers Squibb, and AstraZeneca. L. Ø. reports grants/contracts not related to this study from the Novo Nordisk Foundation. All other authors report no potential conflicts.

Figures

Graphical Abstract
Graphical Abstract
Figure 1.
Figure 1.
Flowchart of study population. The primary study population consisted of 87 257 patients with a de novo cardiac implantable electronic device. Secondary analyses were carried out on all eligible procedures. Abbreviations: CIED, cardiac implantable electronic device; CRT, cardiac resynchronization therapy; ICD, implantable cardioverter defibrillator; PM, pacemaker.
Figure 2.
Figure 2.
Ten-year (A) and 360-day (B) cumulative incidence of Staphylococcus aureus bacteremia after de novo cardiac implantable electronic device implantation accounting for the competing risk of death, both stratified by device type. Abbreviations: CRT, cardiac resynchronization therapy; ICD, implantable cardioverter defibrillator; PM, pacemaker; SAB, Staphylococcus aureus bacteremia.
Figure 3.
Figure 3.
Ten-year all-cause mortality from date of cardiac implantable electronic device implantation, stratified by device type. Abbreviations: CIED, cardiac implantable electronic device; CRT, cardiac resynchronization therapy; ICD, implantable cardioverter defibrillator; PM, pacemaker.
Figure 4.
Figure 4.
Ten-year cumulative incidence of Staphylococcus aureus bacteremia accounting for the competing risk of death, stratified by device type and sex. Abbreviations: CRT, cardiac resynchronization therapy; ICD, implantable cardioverter defibrillator; PM, pacemaker; SAB, Staphylococcus aureus bacteremia.
Figure 5.
Figure 5.
Eight-year cumulative incidence of Staphylococcus aureus bacteremia (SAB) accounting for the competing risk of death, stratified by type of procedure. First = de novo implantation, Exchange = generator exchange, Up-/downgrade = cardiac implantable electronic device upgrade or downgrade.
Figure 6.
Figure 6.
Eight-year cumulative incidence of Staphylococcus aureus bacteremia (SAB) accounting for the competing risk of death, stratified by cumulative number of cardiac implantable electronic device–related procedures.
Figure 7.
Figure 7.
Adjusted multivariable Cox regression model showing risk factors associated with Staphylococcus aureus bacteremia after de novo cardiac implantable electronic device implantation. Abbreviations: CABG, coronary artery bypass grafting; CI, confidence interval; CIED, cardiac implantable electronic device; CRT, cardiac resynchronization therapy; HR, hazard ratio; ICD, implantable cardioverter defibrillator; PM, pacemaker; SAB, Staphylococcus aureus bacteremia.
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References

    1. Blomström-Lundqvist C, Traykov V, Erba PA, et al. European Heart Rhythm Association (EHRA) international consensus document on how to prevent, diagnose, and treat cardiac implantable electronic device infections. Europace 2020; 22:515–49. - PMC - PubMed
    1. Miyagi Y, Sakamoto S, Kawase Y, et al. Temporal and microbiological analysis of cardiac implantable electrical device infections—a retrospective study. Circ Rep 2021; 3:488–96. - PMC - PubMed
    1. Urien JM, Camus C, Leclercq C, et al. The emergence of Staphylococcus aureus as the primary cause of cardiac device–related infective endocarditis. Infection 2021; 49:999–1006. - PubMed
    1. Nakajima I, Narui R, Tokutake K, et al. Staphylococcus bacteremia without evidence of cardiac implantable electronic device infection. Heart Rhythm 2021; 18:752–9. - PubMed
    1. Raatikainen MJP, Arnar DO, Merkely B, et al. A decade of information on the use of cardiac implantable electronic devices and interventional electrophysiological procedures in the European Society of Cardiology countries: 2017 report from the European Heart Rhythm Association. Europace 2017; 19:II1–90. - PubMed

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