1286. A Detailed Look at Culture-Negative Cardiovascular Implantable Electronic Device-Related Pocket Infections
Session: Poster Abstract Session: Bacteremia and Endocarditis
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • IDSA_CIED_poster-2013_DL.pdf (599.3 kB)
  • Background: With an ever-growing number of cardiovascular implantable electronic devices (CIED) implanted, the number of device-related infections is steadily increasing.  Complete removal of device with targeted antimicrobial therapy is critical to manage such complications.  Management of culture-negative CIED pocket infections can be frustrating because of uncertainties related to the optimal antimicrobial therapy and outcomes.  Here we describe clinical characteristics and outcomes of a cohort of culture-negative CIED-related pocket infections.

    Methods: Retrospective chart review.

    Results: A total of 434 patients underwent device extraction for CIED-associated infection at a tertiary referral center between1991–2008; the 298 individuals who had signs and symptoms of a pocket infection were analyzed.  Of these, 49 (16%) had negative cultures. The median age of the cohort was 71 years, and 27 subjects (58.7%) had received antimicrobials. When compared to the pocket infection group with positive cultures, patients had similar rates of localized symptoms including erythema, local pain, swelling and drainage.  In contrast, erosion (61.2% vs 44.2%, p=0.029) was more likely, while purulence in the pocket (56.5% vs 73.7%, p=0.02), fever/chills (6.1% vs 29.3%, p<0.001), or an elevated WBC, were less frequently observed.  The median duration of antimicrobial therapy was 2 weeks in the culture negative group and the one-year all-cause mortality rates were similar between the two groups.

    Conclusion: In our patient cohort, one sixth of all CIED-related pocket infections were culture negative. Purulence, fever/chills, leukocytosis and lack of erosion predicted positive cultures in the patient group treated at our institution for CIED-related pocket infection. There was no difference in outcomes between the two cohorts.  In order to be able to better tailor antibiotic therapy and possibly avoid extraction of device leads in certain cases, in the future, more sensitive (potentially molecular) microbiological diagnostic methods in cases of pocket infection should be utilized. Finally, attempts to improve the yield from biofilm-related infection could be of benefit.

    Sara Taherkhani, M.D.1, Dong Heun Lee, MD2, Amanda M. Michael, DO3, Steven P. Kutalek, MD4 and Ole Vielemeyer, MD2, (1)Department of Infectious Diseases and HIV Medicine, Drexel University College of Medicine, Philadelphia, PA, (2)Division of Infectious Diseases and HIV Medicine, Drexel University College of Medicine, Philadelphia, PA, (3)Infectious Diseases and HIV Medicine, Drexel University, Department of Medicine, Division of Infectious Diseases & HIV Medicine, Philadelphia, PA, (4)Division of Cardiovascular Diseases, Drexel University College of Medicine, Philadelphia, PA

    Disclosures:

    S. Taherkhani, None

    D. H. Lee, None

    A. M. Michael, None

    S. P. Kutalek, None

    O. Vielemeyer, None

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