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Risk of Cardiac Implantable Electronic Device Infection in Patients with Bloodstream Infection: Microbiologic Effect in the Era of Positron Emission Tomography–Computed Tomography

  • Invasive Electrophysiology and Pacing (EK Heist, Section Editor)
  • Published:
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Abstract

Purpose of Review

Bloodstream infection (BSI) in patients with cardiac implantable electronic devices (CIEDs) is common and can prompt challenges in defining optimal management. We provide a contemporary narrative review of this topic and propose a pathogen-dependent clinical approach to patient management.

Recent Findings

BSI due to staphylococci, viridans group streptococci, and enterococci is associated with an increased risk of underlying CIED infection, while the risk of CIED infection due to other organisms is poorly defined. There is growing evidence that positron emission tomography–computed tomography may be helpful in some patients with BSI and underlying CIED.

Summary

Twenty studies were included to examine the impact of microbiologic findings on the risk of CIED infection among patients with BSI. Diagnosis of CIED infection in patients with BSI without pocket findings is often difficult, necessitating the use of novel diagnostic tools to help guide the clinician in subsequent patient management.

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Abbreviations

AICD:

Automatic implantable cardioverter-defibrillator

BSI:

Bloodstream infection

CI:

Confidence interval

CIED:

Cardiac implantable electronic device

CoNS:

Coagulase-negative staphylococci

CRT-D:

Cardiac resynchronization therapy-defibrillator

CRT-P:

Cardiac resynchronization therapy-pacemaker

EHRA:

European Heart Rhythm Association

FDG:

Fluorodeoxyglucose

GNB:

Gram-negative bacteremia

LVAD:

Left ventricular assist device

Non-SA GPC:

Non-Staphylococcus aureus gram-positive cocci

PET-CT:

Positron emission tomography–computed tomography

PPM:

Permanent pacemaker

SAB:

Staphylococcus aureus bacteremia

TEE:

Transesophageal echocardiography

VGS:

Viridans group streptococci

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Authors and Affiliations

  1. Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Supavit Chesdachai, Daniel C. DeSimone & Larry M. Baddour

  2. Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA

    Daniel C. DeSimone & Larry M. Baddour

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Larry M. Baddour reports the following: UpToDate, Inc. (royalty payments — authorship duties), Boston Scientific (consultant duties), Roivant Sciences (consultant duties), and Botanix Pharmaceuticals (consultant duties). The other authors declare that they have no conflict of interest.

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Chesdachai, S., DeSimone, D.C. & Baddour, L.M. Risk of Cardiac Implantable Electronic Device Infection in Patients with Bloodstream Infection: Microbiologic Effect in the Era of Positron Emission Tomography–Computed Tomography. Curr Cardiol Rep 25, 781–793 (2023). https://doi.org/10.1007/s11886-023-01900-y

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