1076. Impact of Diabetes Mellitus on Clinical Presentation and Outcome of Patients with Cardiovascular Implantable Electronic Device Infections
Session: Poster Abstract Session: Infection in Immunocompromised Patients
Saturday, October 22, 2011
Room: Poster Hall B1
Handouts
  • CIED infection_diabetes_IDSA 2011.pptx.pdf (1.4 MB)
  • Background: Hyperglycemia is known to impair host immune response by interfering with leukocyte migration and function. In this investigation, we sought to examine the differences in clinical presentation and outcome of patients with cardiovascular implantable electronic device (CIED) infection with and without diabetes mellitus. 

    Methods: We retrospectively reviewed all cases of CIED infection admitted to Mayo Clinic Rochester from January 1991 to December 2008. Clinical manifestations of CIED infection and prevalence of CIED-IE between patients with and without diabetes were compared using rank sum, chi-square and Fisher’s exact tests.

     

    Results: We identified 415 patients with CIED infection during the study period.  Of these, 115 (28%) of the patients had diabetes. As expected, patients with diabetes were more likely to have higher body mass index, renal insufficiency, coronary atherosclerosis and peripheral vascular disease. Patients with diabetes were more likely to present with blood stream infection (61% vs. 41%, p<0.001) compared to non-diabetics. Consequently, fever (50% vs. 37%, p=0.01) and chills (39% vs. 27%, p=0.02) were more common in patients with diabetes compared to non-diabetics, who were more likely to present with swelling (49% vs. 36%, p=0.01) and drainage (43% vs. 28%, p=0.005) from the generator pocket. Interestingly, diabetics had higher frequency of Staphylococcus aureus infection (39% vs. 28%, p=0.03) compared to non-diabetics. Patients with diabetes were also more likely to have distant metastatic foci on infection (10% vs. 3%, p=0.005). While 30-day survival between the two groups was similar, diabetics had poor long-term survival compared to non-diabetics (p=0.013).

    Conclusion: Patients with diabetes are more likely to present with systemic manifestations of CIED infection and associated complications compared to non-diabetics. However, short-term infection-related morality between the two groups is similar.

     


    Subject Category: C. Clinical studies of bacterial infections and antibacterials including sexually transmitted diseases and mycobacterial infections (surveys, epidemiology, and clinical trials)

    Omer Sultan, MBBS1, Katherine Y. Le, MD, MPH2, Larry M. Baddour, MD3, Christine Lohse4, Paul A. Friedman, MD2, David Hayes, MD5, Walter R. Wilson, MD2, James Steckelberg, MD, FIDSA6 and Muhammad R. Sohail, MD2, (1)Critical care , Mayo Clinic , Rochester , MN, (2)Mayo School of Graduate Medical Education, Rochester, MN, (3)Mayo Clinic, Rochester, MN, (4)Mayo Clinic , Rochester , MN, (5)Mayo Clinic College of Medicine, Rochester, MN, (6)Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Rochester, MN

    Disclosures:

    O. Sultan, None

    K. Y. Le, None

    L. M. Baddour, None

    C. Lohse, None

    P. A. Friedman, Medtronic, St. Jude, Guidant, Astra Zeneca: Consultant and Research Contractor, Consulting fee, Research grant and Speaker honorarium

    D. Hayes, Medtronic, St. Jude, Guidant, Boston Scientific: Consultant, Investigator and Research Contractor, Consulting fee, Research grant, Research support and Speaker honorarium

    W. R. Wilson, None

    J. Steckelberg, None

    M. R. Sohail, None

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.