Shorter duration of antibiotics (<=2 weeks) after complete CIED removal resulted in similar survival compared to >2 weeks duration (HR 0.693; 95% CI 0.085-5.652; p=0.438).
Cohort (n=79)
No
Does antimicrobial therapy for ⩽2 weeks post-extraction maintain similar outcomes compared to >2 weeks in patients undergoing CIED removal for bacteremia or lead endocarditis?
Shorter duration of antibiotics (⩽2 weeks) after complete CIED removal for systemic infection showed similar rates of mortality and recurrent bacteremia compared to longer durations.
Effect estimate: HR 0.693 (95% CI 0.085-5.652)
p-value: p=0.438
Background: While the need for complete device removal is well-established for cardiovascular implantable electronic device (CIED) infections, there is insufficient evidence on the optimal duration of antimicrobial therapy. Objectives: To examine how antimicrobial duration affects clinical outcomes of patients presenting with CIED-associated bacteremia and lead endocarditis. Design: This is a retrospective cohort study conducted at a quaternary care hospital in Houston, TX, USA. Methods: Patients who underwent device removal for a primary indication of bacteremia or lead endocarditis over a 10-year period were stratified by prescribed duration of antibiotics as ⩽2 weeks or >2 weeks post-extraction. Measured outcomes included all-cause mortality at 90 days, recurrent bacteremia, infectious complications, and hospital length of stay. Results: Of 747 patients who underwent lead extraction at Baylor St. Luke’s Medical Center between June 2013 and December 2023, 79 cases met the inclusion criteria. Baseline characteristics were similar between cohorts. Mean duration of antibiotics prescription was 12.6 versus 38.6 days. There was no observed difference in survival (HR 0.693, 95% CI 0.085–5.652, p = 0.438), recurrent bacteremia (7% vs 6%, p = 0.952), infectious complications (27% vs 30%, p = 0.817), and hospital length of stay (mean 9.9 vs 13.3, p = 0.360) between the ⩽2 weeks and >2 weeks cohort, respectively. Five patients had recurrence, all of whom had bacteremia from Staphylococcus aureus or Serratia sp. and an underlying left ventricular assist device or valve replacement. Conclusion: Shorter duration of antibiotics after complete CIED removal had similar rates of mortality or recurrent bacteremia. Recurrence was associated with bacteremia from high-risk organisms with potential for secondary seeding of other cardiovascular prostheses. Larger prospective studies are needed to explore these findings.
Xiao et al. (Fri,) conducted a cohort in CIED-associated bacteremia and lead endocarditis (n=79). Antibiotics <=2 weeks post-extraction vs. Antibiotics >2 weeks post-extraction was evaluated on All-cause mortality at 90 days (HR 0.693, 95% CI 0.085-5.652, p=0.438). Shorter duration of antibiotics (<=2 weeks) after complete CIED removal resulted in similar survival compared to >2 weeks duration (HR 0.693; 95% CI 0.085-5.652; p=0.438).
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