Staphylococcus aureus bacteremia and cardiac implantable electronic devices in a county hospital setting: a population-based retrospective cohort study

Abstract

Background: Due to a high incidence of cardiac implantable electronic device-associated infective endocarditis (CIED-IE) in cases of Staphylococcus aureus bacteremia (SAB) and high mortality with conservative management, guidelines advocate device removal in all subjects with SAB. We aimed to investigate the clinical course of SAB in patients with a CIED (SAB+CIED) in a Swedish county hospital setting and relate it to guideline recommendations.
 Methods: All CIED carriers with SAB, excluding clinical pocket infections, in the County of Västmanland during 2010–2017 were reviewed retrospectively.
 Results: There were 61 cases of SAB+CIED during the study period, and CIED-IE was diagnosed in 13/61 (21%) cases. In-hospital death occurred in 19/61 (31%) cases, 34/61 (56%) cases were discharged with CIED device retained, and 8/61 (13%) cases were discharged after device removal. Subjects dying during hospitalization were elderly and diseased. No events was seen if the CIED was removed. Among four discharged cases with conservatively managed CIED-IE one relapse occured. Among 30 cases discharged with retained CIED and no evidence of IE, 22/30 (73%) cases had an uneventful follow-up, whereas adverse events secondary to overlooked CIED-IE were likely in 1/30 (3%) cases and could not be definitely excluded in additionally 4/30 (13%) cases.
 Conclusions: During the study period, management became more active and prognosis improved. The heterogeneity within the population of SAB+CIED suggests that a management strategy based on an individual risk/benefit analysis could be an alternative to mandatory device removal.

Prevalence of infective endocarditis from dental procedures

“…Bacteremia may occur any time the mucosal surface (oropharyngeal, genitourinary, gastrointestinal, and respiratory) and skin are broken and may even occur spontaneously during chewing in patients with periodontitis 12 . Thus, the bacteria which inadvertently enter the bloodstream may colonize heart valves and implantable medical devices, with this being a common cause of infective endocarditis 13 . genus, from the HACEK (Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, Kingella) group, which causes 1-3% of all infective endocarditis cases.…”

Prevalencia de endocarditis infecciosa a partir de procedimientos odontológicos

“…Puede ocurrir bacteriemia en cualquier caso donde haya pérdida de la continuidad de las mucosas (orofaríngea, genitourinaria, gastrointestinal, respiratoria) y piel, e incluso, de forma espontánea durante la masticación en pacientes con periodontitis 12 . Por lo tanto, las bacterias que ingresan al torrente sanguíneo de forma inadvertida pueden llegar a colonizar válvulas cardíacas y dispositivos médicos implantables, siendo esta una causa común de endocarditis infecciosa 13 .…”

Performance of Risk Scores in Predicting Infective Endocarditis in Patients with Staphylococcus aureus Bacteraemia in a Prospective Asian Cohort

“…In recent years, Staphylococcus aureus has been demonstrated to be the commonest cause of IE [4]. In many ways, the increased incidence of SAB, and in particular, healthcare-associated acquisition of the bacteraemia, appeared to be related to the higher usage of central lines and intracardiac devices [5]. The lines and 2 of 10 devices act as foreign material that allow for bacterial seeding.…”