Among 61 CIED carriers with Staphylococcus aureus bacteremia, in-hospital mortality was 31%, and 73% of cases discharged with retained devices and no evidence of endocarditis had an uneventful follow-up.
Cohort (n=61)
No
What is the clinical course and outcome of Staphylococcus aureus bacteremia in patients with a cardiac implantable electronic device managed with or without device removal?
The heterogeneity in outcomes among CIED patients with Staphylococcus aureus bacteremia suggests that individualized risk/benefit analysis may be a viable alternative to guideline-mandated device removal.
BACKGROUND: bacteremia (SAB) and high mortality with conservative management, guidelines advocate device removal in all subjects with SAB. We aimed to investigate the clinical course of SAB in patients with a CIED (SAB+CIED) in a Swedish county hospital setting and relate it to guideline recommendations. METHODS: All CIED carriers with SAB, excluding clinical pocket infections, in the County of Västmanland during 2010-2017 were reviewed retrospectively. RESULTS: There were 61 cases of SAB+CIED during the study period, and CIED-IE was diagnosed in 13/61 (21%) cases. In-hospital death occurred in 19/61 (31%) cases, 34/61 (56%) cases were discharged with CIED device retained, and 8/61 (13%) cases were discharged after device removal. Subjects dying during hospitalization were elderly and diseased. No events was seen if the CIED was removed. Among four discharged cases with conservatively managed CIED-IE one relapse occured. Among 30 cases discharged with retained CIED and no evidence of IE, 22/30 (73%) cases had an uneventful follow-up, whereas adverse events secondary to overlooked CIED-IE were likely in 1/30 (3%) cases and could not be definitely excluded in additionally 4/30 (13%) cases. CONCLUSIONS: During the study period, management became more active and prognosis improved. The heterogeneity within the population of SAB+CIED suggests that a management strategy based on an individual risk/benefit analysis could be an alternative to mandatory device removal.
Pichtchoulin et al. (Fri,) conducted a cohort in Staphylococcus aureus bacteremia in patients with a cardiac implantable electronic device (n=61). Conservative management (retained CIED) vs device removal was evaluated on Clinical course including in-hospital death and adverse events. Among 61 CIED carriers with Staphylococcus aureus bacteremia, in-hospital mortality was 31%, and 73% of cases discharged with retained devices and no evidence of endocarditis had an uneventful follow-up.