Key result
Obesity, higher comorbidities, and right subclavian access linked to greater Gram-negative CIED infection risk.
Why the study?
Cardiovascular implantable electronic device (CIED) infections are mainly due to Gram-positive bacteria, and data regarding Gram-negative bacterial CIED infections are limited.
What are the risk factors and outcomes associated with Gram-negative bacterial infection of cardiovascular implantable electronic devices compared to Gram-positive or no infection?
Case-Control (n=236)
Yes
What are the risk factors and outcomes associated with Gram-negative bacterial infection of cardiovascular implantable electronic devices compared to Gram-positive or no infection?
Answers are grounded in this paper and cite their sources.
Obesity, higher comorbidity burden, and right subclavian vein implantation site are significant risk factors for Gram-negative CIED infections, which may be associated with higher mortality.
BACKGROUND: Infections of cardiovascular implantable electronic devices (CIED) are mainly due to Gram-positive bacteria (GPB). Data about Gram-negative bacteria CIED (GNB-CIED) infections are limited. This study aimed to investigate risk factors, clinical and diagnostic characteristics, and outcome of patients with GNB-CIED. METHODS: A multicentre, international, retrospective, case-control-control study was performed on patients undergoing CIED implantation from 2015 to 2019 in 17 centres across Europe. For each patient diagnosed with GNB-CIED, one matching control with GPB-CIED infection and two matching controls without infection were selected. RESULTS: A total of 236 patients were enrolled: 59 with GNB-CIED infection, 59 with GPB-CIED infection and 118 without infection. No between-group differences were found regarding clinical presentation, diagnostic and therapeutic management. A trend toward a higher rate of fluorodeoxyglucose positron emission computed tomography (FDG PET/CT) positivity was observed among patients with GNB than in those with GPB-CIED infection (85.7% vs. 66.7%; P = 0.208). Risk factors for GNB-CIED infection were Charlson Comorbidity Index Score (relative risk reduction, RRR = 1.211; P = 0.011), obesity (RRR = 5.122; P = 0.008), ventricular-pacing ventricular-sensing inhibited-response pacemaker implantation (RRR = 3.027; P = 0.006) and right subclavian vein site of implantation (RRR = 5.014; P = 0.004). At 180-day survival analysis, GNB-CIED infection was associated with increased mortality risk (HR = 1.842; P = 0.067). CONCLUSIONS: Obesity, high number of comorbidities and right subclavian vein implantation site were associated with increased risk of GNB-CIED infection. A prompt therapeutic intervention that may be guided using FDG PET/CT is suggested in patients with GNB-CIED infection, considering the poorer outcome observed in this group.
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Pascale et al. (2023) conducted a case-control in Cardiovascular implantable electronic device (CIED) infection (n=236). Obesity (Risk Factor) vs. Non-obese was evaluated on Diagnosis of Gram-negative CIED infection (RRR 5.122, 95% CI 1.536-17.085, p=0.008). Obesity, a higher Charlson Comorbidity Index, and right subclavian vein implantation site were significantly associated with an increased risk of Gram-negative cardiovascular implantable electronic device infection.
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