Key Points
- To identify whether specific clinical or laboratory variables can predict the successful salvage of infected cardiovascular implantable electronic devices treated with antimicrobial therapy without immediate removal.
- Analyzed data from the Multicenter Electrophysiologic Device Infection Collaboration (MEDIC), a prospective, observational, multinational cohort study.
- Evaluated 433 adult patients with confirmed CIED infections categorized into immediate device explantation (n = 306) and attempted device salvage with antimicrobial therapy (n = 127).
- Of the 127 patients undergoing attempted salvage, overall salvage failure occurred in 101 patients (79.5%), including 74 early failures (58.3%) requiring in-hospital explantation and 27 late failures (21.3%), whereas only 26 patients (20.5%) achieved successful salvage.
- Comparison between salvage failure (n = 101) and successful salvage (n = 26) revealed no clinical or laboratory predictors capable of forecasting successful salvage.
- Univariate analysis showed that infection with coagulase-negative staphylococci (P = 0.0439) and the presence of lead vegetation (P = 0.024) were significantly associated with failed salvage.
Structured PICO
Are there clinical factors that predict successful salvage of infected cardiovascular implantable electronic devices?
PPopulation433 adult patients with cardiovascular implantable electronic device (CIED) infections from a multinational cohort
IInterventionMedical management with device retention and antimicrobial therapy (attempted salvage)
CComparatorImmediate device explantation (though primary analysis compared successful vs. failed salvage within the attempted salvage group)
OOutcomeClinical predictors of successful salvage of infected devices
Attempted salvage of infected CIEDs has a high failure rate and lacks reliable clinical predictors of success, supporting current guidelines that mandate early device explantation.