Does extraction of cardiac implantable electronic devices improve outcome in patients with Staphylococcus aureus bacteraemia?

Abstract

Background: Staphylococcus aureus bacteraemia (SAB) is recognized as an infection that is difficult to treat and with high risk of device related infection. Extraction/explantation of cardiac implantable electronic devices (CIED) is recommended in SAB patients but studies evaluating long-term prognosis are scarce. Materials and methods: In this retrospective cohort study, 626 consecutive SAB patients were identified in routine diagnostics (November 2014–October 2016). Patient characteristic, infective endocarditis (IE) incidence and mortality were compared for patients with and without CIED. Results: SAB patients with CIED (n = 33) compared to non-CIED patients (n = 593) were older (83 versus 70 years, p =.0001), had a higher 30-day mortality (12/33, 36% versus 119/593, 20%, p =.044) and higher incidence of IE (9/33, 27% versus 41/593, 7%, p =.0006). One-year mortality was 19/33 (58%) among the SAB CIED patients. Echocardiography was performed in all nine patients with CIED-IE but only in 14/24 (58%) of the 24 SAB CIED patients that were considered not having IE. However, if patients with very early mortality were excluded, echocardiography was performed in 14/17 (82%) of SAB CIED-non-IE patients. CIED extraction/explantation during intravenous antibiotic treatment was only performed in three patients with SAB CIED-IE and in one non-IE patient. One year post treatment initiation, 14 out of 33 SAB CIED patients were alive of whom only one had CIED extraction/explantation performed as part of treatment. Conclusion: Staphylococcus aureus bacteraemia in CIED patients is associated with poor prognosis but in a subgroup of patients survival beyond one year was seen despite retainment of the electronic device.