1085. Enterococcal Cardiac Implantable Electronic Device (CIED) Infections: Clinical Features and Outcomes.
Session: Poster Abstract Session: Bacteremia and Endocarditis
Friday, October 5, 2018
Room: S Poster Hall
Posters
  • Enterococcal CIED Infections IDWeek Poster_v5_Sep 23 REV 1.pdf (106.5 kB)
  • Background: Unlike enterococcal native and prosthetic valve infective endocarditis (IE), enterococcal CIED infections are not well described.

    Methods: Data from the Multicenter Electrophysiologic Device Infection Collaboration (MEDIC), a prospective, observational, multinational cohort study of CIED infections, were used to provide a descriptive analysis of adult patients with CIED infections due to enterococcal species.

    Results: Of 433 patients, 21 (4.8%) were diagnosed with enterococcal CIED infection. Specific data on enterococcal species and antimicrobial susceptibilities were not recorded. The mean age was 70.8 years. No patient had previous CIED infection. Twelve patients (57%) had permanent pacemakers, 5 (24%) had implantable cardioverter defibrillators, and 4 (19%) had biventricular devices. Among the 21 infections, 3 (14%) were categorized as CIED-related bloodstream infections and 18 (86%) as IE; no patient had isolated pocket infection. Of the IE cases, 4 were valvular IE, 8 were lead IE, and 6 were both. Fourteen cases of IE (78%) were definite by the modified Duke criteria. Median time from last device procedure to infection was 510d (range 37-2952d). The most common presenting symptom was fever (48%); 5 patients (24%) exhibited local signs of pocket infection. All 21 patients underwent TEE with vegetations demonstrated in 17 (81%). Blood cultures grew enterococci from all patients. The most common antimicrobial regimen was a penicillin plus aminoglycoside (38%); 2 patients (9.5%) received ampicillin + ceftriaxone. Antibiotics were given for a median of 43d. Only 14 patients (67%) had complete device removal; the 7 patients retaining their device were judged to be at high risk for extraction. There was 1 death during the index hospital stay with 4 additional patients dying over the 6 months after therapy (overall mortality 24%); 2 of 7 patients retaining their CIED died.

    Conclusion: Enterococci caused 4.8% of all CIED infections in our cohort. Most infections appeared to be hematogenous in origin with late onset. IE was the most common infectious syndrome. A penicillin plus aminoglycoside, given for 6 weeks, was the most frequent therapy. Only 67% of patients underwent device removal. At 6 months follow-up, no relapses had occurred but overall mortality was 24%.

    Timothy S Oh, BS1, James E Peacock Jr., MD1, Katherine Le, MD2, M Rizwan Sohail, MD2, Larry M Baddour, MD2, Holenarasipur R Vikram, MD3, Jose M Miro, MD, PhD4, Jordan M Prutkin, MD, MHS5, Arnold J Greenspon, MD6, Roger G Carrillo, MD7, Stephan B Danik, MD8, Christoph K Naber, MD, PhD9, Elisabeth Blank, MD9, Chi-Hong Tseng, PhD10 and Daniel Z Uslan, MD10, (1)Wake Forest School of Medicine, Winston-Salem, NC, (2)Mayo Clinic College of Medicine, Rochester, MN, (3)Mayo Clinic, Scottsdale, AZ, (4)Hospital Clinic-IDIBAPS, Barcelona, Spain, (5)University of Washington, Seattle, WA, (6)Thomas Jefferson University Hospital, Philadelphia, PA, (7)Miller School of Medicine, Miami, FL, (8)Harvard Medical School, Boston, MA, (9)Contilia Heart and Vascular Ctr, Essen, Germany, (10)David Geffen School of Medicine, Los Angeles, CA

    Disclosures:

    T. S. Oh, None

    J. E. Peacock Jr., Pfizer, Inc.: Shareholder , Owns common stock in Pfizer which was inherited and held in a trust .

    K. Le, None

    M. R. Sohail, TyRx Inc: Investigator , Research support . Medtronic Inc: Investigator , Research support . Medtronic Inc: Consultant , Speaker honorarium . Spectranetics: Consultant , Speaker honorarium . Boston Scientific Corp: Consultant , Speaker honorarium .

    L. M. Baddour, UpToDate: Collaborator , Royalty payment .

    H. R. Vikram, None

    J. M. Miro, Abbvie: Consultant and Grant Investigator , Consulting honoraria and Research grant . Bristol-Myers Squibb: Consultant and Grant Investigator , Consulting honoraria and Research grant . Genentech: Consultant and Grant Investigator , Consulting honoraria and Research grant . Medtronic: Consultant and Grant Investigator , Consulting honoraria and Research grant . Novartis: Consultant and Grant Investigator , Consulting honoraria and Research grant . Gilead Sciences: Consultant and Grant Investigator , Consulting honoraria and Research grant . Pfizer: Consultant and Grant Investigator , Consulting honoraria and Research grant . ViiV Healthcare: Consultant and Grant Investigator , Consulting honoraria and Research grant .

    J. M. Prutkin, None

    A. J. Greenspon, Medtronic: Consultant , Speaker honorarium . Boston Scientific: Consultant , Speaker honorarium . St. Jude: Consultant , Speaker honorarium .

    R. G. Carrillo, St. Jude Medical Group: Speaker's Bureau , Research support . Spectranetics: Consultant , Speaker honorarium . Sorin Group: Speaker's Bureau , None . Boston Scientific Corp: Speaker's Bureau , None .

    S. B. Danik, None

    C. K. Naber, None

    E. Blank, None

    C. H. Tseng, None

    D. Z. Uslan, Medtronic: Investigator , Research support . Boston Scientific: Consultant , Speaker honorarium .

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.