302. Current management of cardiac implantable electronic device infections: results of an Emerging Infections Network survey
Session: Poster Abstract Session: HAI: Device Associated Infections
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • ID Week 2015 EIN Pacemaker Survey.pdf (295.8 kB)
  • Background: Infectious disease (ID) specialists are frequently involved in the care of patients with cardiac implantable electronic device (CIED) infections.  While guidelines exist for managing these infections, supporting literature is largely based on expert opinion.  We sought to better understand current CIED treatment practices of ID physicians. 

    Methods: A seven-question electronic survey of ID physician members of the Emerging Infections Network (EIN), a CDC-sponsored sentinel network, in late January 2015.

    Results: 543/1,185 (46%) EIN members responded.  We excluded 183/543 (34%) respondents who had not treated CIED infections in the past year.  166/360 (46%) reported having treated <5 CIED infections in the past year.  Respondents predominantly favored complete device removal for patients with a pocket infection [293/359 (82%)] or lead-associated endocarditis [356/360 (99%)].  Complete removal was less frequently [164/358 (46%)] recommended for occult bacteremia, and few [40/355 (11%)] felt it necessary when bacteremia was attributable to a non-cardiovascular source.  Isolation of S. aureus was a key reason for recommending complete device removal.  Respondents were more likely to treat S. aureus bacteremia with antibiotics for >4 weeks compared to Gram-positive bacteremia other than S. aureus or Gram-negative bacteremia (64%, 31%, and 23%, respectively; p<0.0001).  306/355 (86%) treated lead-associated endocarditis for >4 weeks.  175/355 (49%) of respondents favored a brief device-free interval (2-6 days) until CIED reimplantation in patients with a pacemaker-dependent arrhythmia, but 260/356 (73%) favored waiting ≥1 week for patients requiring a CIED for primary prevention of sudden cardiac death and 246/353 (70%) for secondary prevention.  For patients with lead-associated endocarditis where complete CIED removal was not possible, respondents favored chronic suppression with oral antibiotics after initial intravenous therapy [33/360 (93%)]; most recommended treatment for an indefinite period [239/329 (73%)].

    Conclusion: In the setting of CIED infections, ID physicians favored a combination of complete device removal and prolonged antibiotic therapy, particularly in the setting of S. aureus infection.

    Stephen Liang, MD1, Susan E. Beekmann, RN, MPH2, Philip M. Polgreen, MD2 and David K. Warren, MD, MPH, FIDSA, FSHEA1, (1)Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, (2)Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA

    Disclosures:

    S. Liang, None

    S. E. Beekmann, None

    P. M. Polgreen, None

    D. K. Warren, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.