Causative Organisms in CIED infections – The SZMC experience

Background : Despite recent developments, in anti-septic techniques and usage of devices that are leadless or extra vascular, numbers of intravascular cardiac implantable electronic device (CIEDs) infections is rising exponentially, unproportioned to the increased rate of implantations . Guideline based antibiotic prophylactic protocols aimed to prevent staphylococcal infections .

Objectives: To describe the causative organisms of CIEDs infections treated at Shaare Zedek medical center.

Methods: All consecutive patients with CEID related infection during the last 10 years were included. Patients’ characteristics, as well as causative organisms, were reviewed from the electronic medical records.

Results: Fifty-one patients with CIED related infection were identified, 21 (41%) with pocket infection, 12 (23%) with systemic infection and 18 (34%) with combined pocket and systemic infection. Time from device implantation to infection was 22±28 months for pocket infection and 24±35 months for systemic infection with or without pocket infection (p=ns). For pocket and systemic infections, 33% and 25% occurred within a month from implantation, 28% and 29% within 1-12 month and 38% and 46% > 12 months post implantation, respectively. Patients were divided according to the occurrence of the pocket or systemic infections within 1 year of implantation (n= 30) or later (n=21). The causative organism was staph (MSSA, MRSA or staph coagulase negative) in ~ 60% of cases both before or after 1 year from implantation. However, gram negative infection was seen in 23% of cases in the first-year post implantation compared to 8% thereafter (p=ns) (Graph).

Gram negative infection were caused by pseudomonas aeruginosa , Klebsiella pneumonia, and E-coli , 43% of the G-ve infections were not sensitive to current regimen of antibiotic prophylaxis.

Conclusion: Gram negative infections were seen in 23% of CIEDs related infections within 1 year of implantation and in 43% were not covered by current regimen of antibiotic prophylaxis.