July 05, 2017
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Cardiac device-related infection risk depends on bacterial species

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The risk for cardiac device-related infection in patients with bacteremia depends on the species of bacteria involved, according to researchers.

Three species — Staphylococcus aureus, Pseudomonas aeruginosa and Serratia marcescens — were associated with an increased risk for cardiac device-related infection (CDRI), they wrote in Open Forum Infectious Diseases.

Vance Fowler
Vance G. Fowler

“Although P. aeruginosa and S. marcescens were infrequent causes of bacteremia in patients with cardiac devices, they have comparable CDRI risk to that of S. aureus when present,” the researchers wrote.

Vance G. Fowler, MD, professor of medicine and molecular genetics and microbiology at Duke University School of Medicine, and colleagues enrolled 2,571 patients with either S. aureus bacteremia (SAB) or gram-negative bacteremia (GNB). The patients were treated at Duke Medical Center and Duke Regional Hospital between October 2002 and December 2014.

Of those patients, 284 had at least one cardiac device at the time of bacteremia. And of that cohort, 152 patients (53.5%) had SAB, whereas 132 (46.5%) had GNB. In addition, 83 (54.6%) of the patients with SAB and 22 (16.7%) of those with GNB had definite CDRI.

The researchers further categorized the 284 patients based on the type of cardiac device. Among them, 150 patients (52.8%) had permanent pacemakers or automatic implantable cardioverter defibrillators, 72 (25.4%) had prosthetic heart valves, 4 (1.4%) had left ventricular assist devices and 58 (20.4%) had more than one device.

Patients with a cardiac device with S. aureus (OR = 5.57; 95% CI, 2.16-14.36), P. aeruginosa (OR = 50.28; 95% CI, 4.16-606.93) or S. marcescens (OR = 7.75; 95% CI, 1.48-40.48) faced an increased CDRI risk compared with patients who had bacteremia caused by all other gram-negative bacilli species.

The researchers said their results may mean that the CDRI risk posed by Pseudomonas and Serratia bacteremia is nearing that of SAB, which has implications for patient care.

“The results of this study suggest that patients with a cardiac device who develop bacteremia due to either Pseudomonas or Serratia should be considered for echocardiography or other appropriate diagnostic studies to evaluate for CDRI,” they wrote. – by Joe Green

Disclosure: Maskarinec reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.

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