1282. Occult bacteremia associated with Cardiovascular Implantable Electronic Device related Infections
Session: Poster Abstract Session: Bacteremia and Endocarditis
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • CIED_IE_IDSA2013_DL.pdf (5.5 MB)
  • Background: An expansion of cardiovascular implantable electronic device (CIED) use has led to an increased number of device-related infections. When extraction is required a transesophageal echocardiography (TEE) is often performed to help determine the appropriate length of antimicrobial therapy and the safe time point for re-implantation. Optimal duration of antimicrobials and outcomes of patients with bacteremia but without evidence of endovascular infection on TEE or signs of pocket infection (occult bacteremia) is unclear. We describe clinical characteristics of a cohort who had undergone device extraction from occult bacteremia related to CIED infections.

    Methods: We reviewed records of 434 patients undergoing device extraction for CIED-associated infection at a tertiary referral center between 1991– 2008; 123 individuals (28%) who had bacteremia without evidence of pocket site infection and underwent TEE were analyzed.

    Results: Of 123 individuals, 26 (21%) had no evidence of endovascular infection (vegetation) on TEE.  The median duration of symptoms prior to extraction was 28 days. When compared to the positive TEE group, patients had similar rates of systemic symptoms including fever/chills and hypotension. Staphylococcusspecies isolated in 21 patients (81%) and less than a half (46%) had other potential source of infection. Median duration of antimicrobial therapy was 6 weeks and one third received a new device during the same hospitalization. The one-year all-cause mortality rates were similar between the two groups.        

    Conclusion: In our cohort of CIED related infections without evidence of pocket site involvement and with TEE performed, approximately one fifth had occult bacteremia. Clinical presentations and isolated pathogens were similar to the group with a positive TEE finding. There was no difference in outcomes between the two cohorts treated at our institution. Thus, especially in critically ill cardiac patients presenting with occult bacteremia, it may be prudent to treat in the same way as groups with a positive TEE finding; the role of TEE should be reconsidered in such a population. Further diagnostic imaging should be investigated to evaluate primary bacteremia in patients with CIED to assess need for extraction.

    Amanda M. Michael, DO, Infectious Diseases and HIV Medicine, Drexel University, Department of Medicine, Division of Infectious Diseases & HIV Medicine, Philadelphia, PA, Sara Taherkhani, M.D., Department of Infectious Diseases and HIV Medicine, Drexel University College of Medicine, Philadelphia, PA, Steven P. Kutalek, MD, Division of Cardiovascular Diseases, Drexel University College of Medicine, Philadelphia, PA and Dong Heun Lee, MD, Division of Infectious Diseases and HIV Medicine, Drexel University College of Medicine, Philadelphia, PA

    Disclosures:

    A. M. Michael, None

    S. Taherkhani, None

    S. P. Kutalek, None

    D. H. Lee, None

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