1109. Outcomes in Patients with Cardiovascular Implantable Electronic Device Infection Managed with Chronic Antibiotic Suppression
Session: Poster Abstract Session: Clinical Infectious Diseases: Bacteremia and Endocarditis
Friday, October 28, 2016
Room: Poster Hall
Background:Most cardiovascular implantable electronic device (CIED) recipients are elderly, with multiple comorbidities that are associated with increased risk of CIED infection (CIEDI). Guidelines recommend complete device removal for CIEDI as conservative management is associated with a high risk of relapse and mortality. However, comorbidities or other factors may preclude complete device removal, thus prompting consideration of chronic antibiotic suppression (CAS) after initial response to an infection treatment regimen to prevent infection relapse. Limited data have been published that characterize outcomes in patients receiving CAS for CIEDI.

Methods:We retrospectively screened 660 CIEDI cases from 2005-2015 using Mayo Clinic electronic health records and a CIEDI institutional database, and identified 48 patients who were prescribed CAS. Primary outcomes were infection relapse and mortality at the last available follow-up.

Results: Overall, 48 patients were identified with a median age of 78 years, and 73% (35/48) of them were male. The median Charlson Comorbidity Index was 4, and device removal was not done, for a variety of reasons, namely high surgical risk. The most common causes of CIEDI were coagulase-negative staphylococci (21%, 10/48), methicillin-sensitive S. aureus (MSSA, 19%, 9/48), and Enterococcus species (17%, 8/48). Due to early mortality, 23% (11/48) did not initiate CAS. At 1 month after hospitalization, 25% (12/48) had died, of whom 67% (8/12) had staphylococcal infections. Of the 37 patients who did initiate CAS, the most common antimicrobials used were 22% (8/37) penicillin, 22% (8/37) trimethoprim-sulfamethoxazole, and 19% (7/37) amoxicillin. 15% (6/41 who had follow-up) developed CIEDI relapse within 1 year. Of the 6 relapses, 33% (2/6) subsequently underwent complete device removal.

Conclusion: Complete device removal is recommended for all CIEDI cases because retention is associated with high rates of relapse and mortality. CAS may be reasonable if CIED removal is not feasible. Regardless, 1-month mortality was high, may be related to staphylococcal infections, and is reflective of an older age and comorbid conditions that characterize the CIEDI population.

Eugene M. Tan, MD1, Daniel C. Desimone, MD2, Muhammad R. Sohail, MD, FIDSA3, Larry M. Baddour, MD, FIDSA4, Walter R. Wilson, MD, FIDSA5, James M. Steckelberg, MD, FIDSA4 and Abinash Virk, MD, FIDSA6, (1)Internal Medicine, Mayo Clinic, Rochester, MN, (2)Infectious Diseases, Mayo Clinic College of Medicine, Rochester, MN, (3)200 First Street SW, Mayo School of Graduate Medical Education, Rochester, MN, (4)Infectious Diseases, Mayo Clinic, Rochester, MN, (5)Infectious Diseases, Mayo School of Graduate Medical Education, Rochester, MN, (6)Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Rochester, MN

Disclosures:

E. M. Tan, None

D. C. Desimone, None

M. R. Sohail, Medtronic: Consultant , Consulting fee and Research grant
Spectranetics: Consultant , Consulting fee
Boston Scientific: Consultant , Consulting fee

L. M. Baddour, UpToDate: Consultant , Licensing agreement or royalty
Massachusetts Medical Society: NEJM Journal Watch Infectious Diseases – Editor-in-Chief , Editor-in-Chief duties

W. R. Wilson, None

J. M. Steckelberg, None

A. Virk, None

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