1113. Nonstaphylococcal Infection in Patients with Cardiac Implantable Electronic Devices
Session: Poster Abstract Session: Infections of Cardiovascular Devices
Saturday, October 22, 2011
Room: Poster Hall B1

Background:

Staphylococcus species are the leading cause of Cardiac implantable electronic device (CIED) infection. However, the clinical characteristics of device infection by nonstaphylococcal (NS) pathogens are not well known. Our aim was to determine the incidence and mortality of CIED infection due to NS microorganism.

Methods:

A retrospective review of all patients with CIED-related infection admitted to a single center between January 2004 and October 2009 was conducted. Clinical protocols were used including preoperative transesophageal echocardiogram (TEE), lead tip/tissue/blood cultures, antibiotics, intraoperative exudate, chest X-ray, and laser removal. Descriptive and statistical analysis of the data was performed.

Results:

Of the 394 identified patients with CIED-related infection, 96(24,4%, 76 males, 20 females) had a NS infection and were the focus of the study. Most common diagnosis was 89(92,7%) patients with device endocarditis, 5(5,2%) pocket infection, and bacteremia in 2(2,1%). Isolated microorganisms are showed in table No.1. TEE showed 43(44,8%) intracardiac vegetations. All patients underwent successful complete CIED removal. Mean duration of antibiotic treatment was 23.69.2(range 13-81) days for cardiac device endocarditis and 11.39.4(range 11-34) for pocket infection. No patients had an extraction-associated mortality. Five patients developed septic shock for gram-negative bacteria. Index hospitalization mortality was 6(6.25%) patients.

Conclusion:

NS infections demonstrated to be a less prevalent cause for CIED infection. Pseudomona aeuruginosa was the most common pathogen isolated in our study. Hardware removal results in a low perioperative mortality.

Table No.1Microbiology of Nonstaphylococcal Infection in patients with CIED

Pathogen

Culture +

Gram-negative bacteria

Pseudomona aeuruginosa

23

Escherichia coli

9

Klebsiella pneumoniae

7

Enterobacter cloacae

6

Citrobacter koseri

6

Serratia marcesencs

4

Alcaligenes faecalis

3

Stenotrophomonas maltophilia

3

Total

61

Gram-positive bacteria (excluding Staphylococcus)

Propiniobacterium acnes

7

Enterococcus faecalis

5

Bacillus spp.

3

Streptococcus spp.

2

Diphteroids

3

Total

20

Fungi

Candida albicans

8

Candida parapsillosis

7

Total

15


Subject Category: J. Clinical practice issues

Roger Carrillo, MD, Cardiothoracic Surgery , University of Miami, Miami, FL and Juan D. Garisto, MD, Cardiothoracic Surgery, University of Miami Hospital, Miami, FL

Disclosures:

R. Carrillo, Spectranetics: Speaker's Bureau, Consulting fee
StJude: Speaker's Bureau, Consulting fee

J. D. Garisto, None

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