Key result
Coagulase-negative staphylococci comprise most Gram-positive CIED isolates and show the highest multidrug resistance at ~47%.
Why the study?
Bacterial multidrug resistance drives treatment with expensive, toxic, or pharmacokinetically suboptimal antibiotics, motivating an assessment of multidrug-resistant Gram-positive cocci in CIED infections.
Observational (n=702)
No
Coagulase-negative staphylococci are the most frequent pathogens in CIED infections and exhibit high rates of multidrug resistance, emphasizing the need for region-specific epidemiological data to guide empirical antibiotic therapy.
Answers are grounded in this paper and cite their sources.
Empirical therapy for CIED infections requires local resistance profiling; reinforces importance of region-specific epidemiological data.
Introduction: Bacterial multidrug resistance (MDR) drives treatment with expensive, toxic, or pharmacokinetically suboptimal antibiotics. Objectives: To assess the prevalence of MDR Gram-positive cocci among isolates from cardiac implantable electronic device (CIED) infections at a Polish reference center. Methods: Data come from the “EXTRACT” registry (ClinicalTrials.gov ID NCT05775783), which covers 702 transvenous lead extraction procedures. Blood samples and intraoperative swabs were collected from participants with CIED infection. Results: From 209 cases with isolated pocket infection (PI) (107, 51.2%) or systemic infections (102, 48.8%), 263 Gram-positive cocci were cultured. They were: coagulase-negative staphylococci (CoNS) (177, 67.3%), Staphylococcus aureus (62, 23.6%), enterococci (15, 5.7%), streptococci (8, 3.0%), and others (1, 0.4%). The highest MDR rate was among CoNS (46.9%). CoNS exhibited methicillin resistance (MR-CoNS) in 55.9% with co-resistance to macrolides (73.2%), lincosamides (51.0%), fluoroquinolones (56.1%), aminoglycosides (41.4%), tetracyclines (29.6%), and co-trimoxazole (29.3%). Resistance to daptomycin (5.3%) and linezolid (2.0%) in MR-CoNS was rare. The frequency of MDR S. aureus was 8.1%. Methicillin resistance in S. aureus (MRSA, 6.5%) co-occurred with resistance to macrolides/lincosamides and fluoroquinolones (100% for both) or linezolid (25.0%). All MDR staphylococci were vancomycin-susceptible. High-level aminoglycoside resistance (HLAR) in Enterococcus faecalis (53.8%) was accompanied by levofloxacin co-resistance (66.7%). Conversely, E. faecium HLAR (50.0%) strains showed 100.0% β-lactam resistance. Vancomycin-resistant enterococci (VRE) accounted for 6.7%; the VRE E. faecium strain was tigecycline- and linezolid-susceptible. Among viridans group streptococci, β-lactam and lincosamides resistance was common (40.0% for both), with 50.0% of co-resistance. Conclusions: Epidemiological data may improve the effectiveness of empirical antibiotic therapy for CIED-related infections.
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Łoboda et al. (2026) conducted an observational in Cardiac implantable electronic device (CIED) infections (n=702). Among 263 Gram-positive cocci isolated from 209 CIED infections, coagulase-negative staphylococci were the most common (67.3%) and exhibited the highest multidrug resistance rate (46.9%).
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