Risk factors for Gram-negative bacterial infection of cardiovascular implantable electronic devices: multicentre observational study (CarDINe Study)
Renato Pascale, Alice Toschi, Abdullah Tarık Aslan, Giulia Massaro, Angelo Maccaro, Davide Fabbricatore, Andrea Dell’Aquila, Marco Ripa, Mehmet Emirhan Işık, Yeşim Uygun Kızmaz, Saverio Iacopino, Marta Camici, Francesco Perna, Karolina Akinosoglou, Arta Karruli, Matthaios Papadimitriou‐Olivgeris, Bircan Kayaaslan, Yeşim Aybar Bilir, Emin Evren Özcan, Oğuzhan Ekrem Turan, Muhammed Cihan Işık, Pérez Rodríguez, Belén Loeches Yagüe, Alejandro Martín‐Quirós, Mesut Yılmaz, Sabine Petersdorf, Tom De Potter, Emanuele Durante‐Mangoni, Murat Akova, Antonio Curnis, Dino Gibertoni, Igor Diemberger, Luigia Scudeller, Pierluigi Viale, Maddalena Giannella, Natascia Caroccia, Francesca Fanì, Federica Arbizzani, Ramsiya Ramanathan, Paolo Scarpellini, Alessandra Marzi, Patrizio Mazzone, Filippo Placentino, Giulia Sammarini, Elena Tenti, George Leventopulos, Giulia Domenichini, Meyha Şahin, Milagros Suárez-Varela, Elkin González Villegas
Abstract
BACKGROUND: Infections of cardiovascular implantable electronic devices (CIED) are mainly due to Gram-positive bacteria (GPB). Data about Gram-negative bacteria CIED (GNB-CIED) infections are limited. This study aimed to investigate risk factors, clinical and diagnostic characteristics, and outcome of patients with GNB-CIED. METHODS: A multicentre, international, retrospective, case-control-control study was performed on patients undergoing CIED implantation from 2015 to 2019 in 17 centres across Europe. For each patient diagnosed with GNB-CIED, one matching control with GPB-CIED infection and two matching controls without infection were selected. RESULTS: A total of 236 patients were enrolled: 59 with GNB-CIED infection, 59 with GPB-CIED infection and 118 without infection. No between-group differences were found regarding clinical presentation, diagnostic and therapeutic management. A trend toward a higher rate of fluorodeoxyglucose positron emission computed tomography (FDG PET/CT) positivity was observed among patients with GNB than in those with GPB-CIED infection (85.7% vs. 66.7%; P = 0.208). Risk factors for GNB-CIED infection were Charlson Comorbidity Index Score (relative risk reduction, RRR = 1.211; P = 0.011), obesity (RRR = 5.122; P = 0.008), ventricular-pacing ventricular-sensing inhibited-response pacemaker implantation (RRR = 3.027; P = 0.006) and right subclavian vein site of implantation (RRR = 5.014; P = 0.004). At 180-day survival analysis, GNB-CIED infection was associated with increased mortality risk (HR = 1.842; P = 0.067). CONCLUSIONS: Obesity, high number of comorbidities and right subclavian vein implantation site were associated with increased risk of GNB-CIED infection. A prompt therapeutic intervention that may be guided using FDG PET/CT is suggested in patients with GNB-CIED infection, considering the poorer outcome observed in this group.