Risk of cardiac device-related infection in patients with late-onset bloodstream infection. Analysis on a National Cohort

Cardiac implantable electronic devices and bloodstream infections: management and outcomes

“…Unlike the study by Boix-Palop, which included a large group of patients with prosthetic valves (57%), in which the medical community is significantly more attentive to endocarditis or systemic infection, our study cohort consisted exclusively of patients with de novo ICD or CRT-D implantation and BSI. In line with past literature, 10 , 15 the rate of cardiac imaging in our cohort was as low as 47% and, when performed, TTE was prevalent. This is a surprisingly low rate, especially considering that over half of patients had a Gram-positive pathogen, well-known for resulting in a higher risk for device infection as compared with other pathogens.…”

“…Although the Novel 2019 International CIED Infection Document presented additional criteria for device endocarditis and merged the modified Duke criteria with the 2015 European Society of Cardiology (ESC) criteria, none represent a validated and standardized tool for the diagnosis in this specific setting. A recent study by Boix-Palop et al 10 evaluated patients with late-onset BSI, defined as episodes of clinically significant bacteraemia occurring more than 1 year after implantation or device manipulation. They reported 187 (2.9%) cases of clinically significant bacteraemia out of 6313 patients.…”

“…Late device infection can arise from various non-cardiac sources, as, for example, pneumonia and urogenital tract, gastrointestinal, or orthopaedic infection. 10 As primary care physicians are frequently managing out-of-hospital infections in device patients, limited data exist on the accuracy and timing of the diagnosis of CIED infection in these patients. Furthermore, there is inadequate understanding of the initial infections most likely resulting in a CIED infection.…”