| Autor: |
Nakajima, Ikutaro, Narui, Ryohsuke, Tokutake, Kenichi, Norton, Caleb A., Stevenson, William G., Richardson, Travis D., Ellis, Christopher R., Crossley III, George H., Montgomery, Jay A., Crossley, George H 3rd |
| Zdroj: |
Heart Rhythm; May2021, Vol. 18 Issue 5, p752-759, 8p |
| Abstrakt: |
Background: Staphylococcus bacteremia (SB) in the presence of a cardiac implantable electronic device (CIED) is frequently associated with CIED infection. In patients without clear CIED infection but SB, the role of empirical CIED removal is unclear.Objective: The purpose of this study was to describe the natural history of SB in the setting of a CIED and the effect of CIED removal on mortality in patients with concurrent SB without evidence of CIED infection.Methods: Three hundred sixty consecutive patients (mean age 61 ± 17 years; 255 (71%) men; 329 (92%) Staphylococcus aureus) with a CIED and concurrent SB were reviewed.Results: At the initial presentation with SB, 178 patients had no evidence of CIED infection. Of these, 132 (74%) had another identified source of infection. Among the 178 patients without CIED infection, 18 (10%) had empirical CIED removal during the initial bacteremia. Among those who did not undergo CIED removal, SB subsequently relapsed in 19% and relapse rates were not different for those with or without another identifiable source at the initial presentation. Relapse was strongly associated with the duration of SB >1 day (odds ratio 9.99; 95% confidence interval 3.24-30.86). Despite the absence of CIED infection, 1-year mortality was 35% and empirical device removal during the initial presentation was associated with survival benefit (hazard ratio 0.28; 95% confidence interval 0.08-0.95).Conclusion: For patients with SB without evidence of CIED infection, relapse is predicted by the duration of bacteremia. Empirical CIED removal appears to be associated with a survival benefit, although there are likely clinical situations in which this could be deferred. [ABSTRACT FROM AUTHOR] |
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