Duration of antimicrobial therapy in cardiovascular implantable electronic device associated systemic infections: a retrospective analysis.

Abstract

While the need for complete device removal is well-established for cardiovascular implantable electronic device (CIED) infections, there is insufficient evidence on the optimal duration of antimicrobial therapy. To examine how antimicrobial duration affects clinical outcomes of patients presenting with CIED-associated bacteremia and lead endocarditis. This is a retrospective cohort study conducted at a quaternary care hospital in Houston, TX, USA. Patients who underwent device removal for a primary indication of bacteremia or lead endocarditis over a 10-year period were stratified by prescribed duration of antibiotics as ⩽2 weeks or >2 weeks post-extraction. Measured outcomes included all-cause mortality at 90 days, recurrent bacteremia, infectious complications, and hospital length of stay. Of 747 patients who underwent lead extraction at Baylor St. Luke's Medical Center between June 2013 and December 2023, 79 cases met the inclusion criteria. Baseline characteristics were similar between cohorts. Mean duration of antibiotics prescription was 12.6 versus 38.6 days. There was no observed difference in survival (HR 0.693, 95% CI 0.085-5.652, p = 0.438), recurrent bacteremia (7% vs 6%, p = 0.952), infectious complications (27% vs 30%, p = 0.817), and hospital length of stay (mean 9.9 vs 13.3, p = 0.360) between the ⩽2 weeks and >2 weeks cohort, respectively. Five patients had recurrence, all of whom had bacteremia from Staphylococcus aureus or Serratia sp. and an underlying left ventricular assist device or valve replacement. Shorter duration of antibiotics after complete CIED removal had similar rates of mortality or recurrent bacteremia. Recurrence was associated with bacteremia from high-risk organisms with potential for secondary seeding of other cardiovascular prostheses. Larger prospective studies are needed to explore these findings. A study of how long antibiotics could be used to treat infections of pacemakers and defibrillators Why was the study done? Bacterial infections in the blood and infected pacemaker or defibrillator wires in the heart pose major health concerns in people who have them. If infected, these patients should have their devices removed and be treated with antibiotics to prevent further complications and even death. Most bacterial infections of the blood alone are treated with ⩽2 weeks of antibiotics, and most bacterial infections of heart valves require 4-6 weeks of antibiotics, but very little is known about how long to treat infections of pacemaker and defibrillator wires. This study is the first to explore how long antibiotics should be given for pacemaker and defibrillator wire infections. What did the researchers do? The research team looked at all patients who had pacemaker or defibrillator wires removed due to a bacterial infection in the blood and/or infection of a pacemaker or defibrillator wire over a 10-year period at a hospital in Houston, TX. They grouped these patients by if they were prescribed ⩽2 weeks or >2 weeks of antibiotics and then compared rates of complications and death. What did the researchers find? Of the 747 patients who had pacemaker or defibrillator wires removed over this period, 79 of them had a bacterial blood infection and/or infection of the wires. There was no difference in rates of death, length of hospitalization, or recurrent infection between people prescribed ⩽2 weeks versus >2 weeks of antibiotics. Interestingly, all 5 patients with recurrent infections had the same two types of bacteria (Staphylococcus aureus and Serratia) and prior heart surgeries. What do the findings mean? This study provides some initial insight that shorter lengths of antibiotics may be appropriate for certain patients with pacemaker or defibrillator wire infections. However, patients with high-risk bacteria or certain prior heart surgeries may be at higher risk for recurrent infections. Larger studies are needed to explore these findings.