1115. A Prospective Analysis of Cardiovascular Implantable Electronic Device Infections Due to Staphylococcal Species: The Multicenter Electrophysiologic Device Infection Cohort (MEDIC)
Session: Poster Abstract Session: Infections of Cardiovascular Devices
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Staphylococci are responsible for the majority of cardiovascular implantable electronic device (CIED) infections.  However, to date, limited single-center retrospective data are available that characterize the different syndromes of CIED infections based on a pathogen designation of Staphylococcus aureus or coagulase negative staphylococcus (CoNS).     

Methods: We utilized data from the Multicenter Electrophysiologic Device Infection Cohort (MEDIC), a multinational cohort study of CIED infection, to further explore clinical presentation and outcomes of CIED infection due to S. aureus and CoNS.  Comparisons of host and device-related factors, clinical presentation, and patient outcomes were performed.  

Results: Of 201 cases of CIED infections, 70 (34.3%) were due to S. aureus, 71 (35.3%) were due to CoNS, and 60 (29.8%) were due to other pathogens.  Compared to all other patients with CIED infection, those CoNS pocket infection were less likely to present with fever (OR 0.07 [0.01, 0.41]) or leukocytosis (OR 0.12 [0.04, 0.34]); in contrast, S. aureus endovascular infections were often characterized by fever (OR 5.02 [1.76, 14.03]), and leukocytosis (OR 9.42 [4.34, 20.41]).  Independent of age, sex, host comorbid conditions, and management interventions, when compared to all other cases of CIED infections, S. aureus endovascular infections were associated with a four-fold increased mortality at 6-month follow-up (OR 3.91 [1.43, 10.86]).  

Conclusion: S. aureus and CoNS were responsible for the majority of CIED infections but are distinct in their clinical presentations and patient outcomes.  Recognition of the unique clinical profiles and outcomes associated with these two groups of staphylococci could lead to improvement in patient care and prognosis.


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

Katherine Y. Le, MD, MPH, Mayo School of Graduate Medical Education, Rochester, MN, Larry M. Baddour, MD, Mayo Clinic College of Medicine, Rochester, MN, Muhammad R. Sohail, MD, Mayo Clinic, College of Medicine, Rochester, MN, Jordan M. Prutkin, MD, MHS, Cardiology, University of Washington, Seattle, WA, Arnold J. Greenspon, MD, Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA, Holenarasipur Vikram, MD, FACP, Division of Infectious Diseases Mayo Clinic Hospital, Phoenix, AZ, Stephan B. Danik, MD, Cardiology, Massachusetts General Hospital, Boston, MA, James E. Peacock Jr., MD, Infectious Diseases, Wake Forest University School of Medicine, Winston-Salem, NC, Carlos Falces, MD, Cardiology, Hospital ClÝnic-IDIBAPS. University of Barcelona, Barcelona., Spain, Jose M Miro, MD, Infectious Diseases, Hosp Clin Universitari, Barcelona, Spain, Elisabeth Blank, MD, ─rztin im Studienzentrum Kardiologie, Essen, Germany, Christoph K. Naber, MD, University of Duisburg-Essen, Essen, Germany, Salvador Ninot, Hospital Clinic-IDIBAPS. University of Barcelona, Barcelona, Spain, Roger G. Carillo, MD, MT.SINAI MEDICAL CENTER, MIAMI Beach, FL, Chi-Hong Tseng, MS, Medicine, David Geffen School of Medicine/University of California, Los Angeles, Los Angeles, CA and Daniel Z. Uslan, M.D., Infectious Diseases, David Geffen School of Medicine/University of California, Los Angeles, Los Angeles, CA

Disclosures:

K. Y. Le, None

L. M. Baddour, UpToDate: Royalty payments, Royalty payment
Massachusetts Medical Society (Journal Watch Infectious Diseases): Editorship, Editorship
ACP/PIER : editorial consultant, Editorial consultant

M. R. Sohail, TyRx Pharma, Inc.: Consultant, honoraria

J. M. Prutkin, None

A. J. Greenspon, Medtronic: honoraria, honoraria
Boston Scientific: honoraria, honoraria
St. Jude : honoraria, honoraria

H. Vikram, None

S. B. Danik, None

J. E. Peacock Jr., None

C. Falces, None

J. M. Miro, Novartis: Grant Investigator and Scientific Advisor, Consulting fee, Research grant and Speaker honorarium
Cubist: Grant Investigator and Scientific Advisor, Consulting fee, Research grant and Speaker honorarium
Pfizer: Grant Investigator, Research grant
Theravance: Grant Investigator, Research grant and Speaker honorarium

E. Blank, None

C. K. Naber, None

S. Ninot, None

R. G. Carillo, Spectranetics: Consultant, Salary
Medtronic: Speaker's Bureau, Speaker honorarium
St. Jude Medical Corp: Speaker's Bureau, Speaker honorarium
Sorin Group: Speaker's Bureau, Speaker honorarium
Boston Scientific Corp : Speaker's Bureau, Speaker honorarium
St. Jude Medical Corp : Grant Investigator, Research grant

C. H. Tseng, None

D. Z. Uslan, Medtronic: honoraria, honoraria
BIOTRONIK: honoraria, honoraria
TyRx, Inc : Consultant, Consulting fee

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.