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.
P. M. Polgreen, None
D. K. Warren, None