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Enterococcus faecalis bacteremia, cardiac implantable electronic device, extraction, and the risk of recurrence

Berge, Andreas ; Arkel, Ludvig ; Nilson, Bo LU orcid and Rasmussen, Magnus LU (2022) In Infection 50(6). p.1517-1523
Abstract

Purpose: In all patients with cardiac implantable electronic devices (CIED) and Enterococcus faecalis bacteremia (EfsB), endocarditis (IE) and CIED infection should be suspected. Guidelines recommend extraction of the CIED when CIED infection or IE is diagnosed. Whether extraction of the CIED should be done in other situations with EfsB is not known. We aimed to describe the management and outcome of patients with CIED and monomicrobial EfsB, in relation to extraction and recurrent EfsB. Methods: A population-based cohort of patients with monomicrobial EfsB from January 2014 to November 2020 was identified through microbiology registers in the Region Skåne, Sweden. Data on CIED and other clinical features were collected from medical... (More)

Purpose: In all patients with cardiac implantable electronic devices (CIED) and Enterococcus faecalis bacteremia (EfsB), endocarditis (IE) and CIED infection should be suspected. Guidelines recommend extraction of the CIED when CIED infection or IE is diagnosed. Whether extraction of the CIED should be done in other situations with EfsB is not known. We aimed to describe the management and outcome of patients with CIED and monomicrobial EfsB, in relation to extraction and recurrent EfsB. Methods: A population-based cohort of patients with monomicrobial EfsB from January 2014 to November 2020 was identified through microbiology registers in the Region Skåne, Sweden. Data on CIED and other clinical features were collected from medical records. Results: Among 1087 episodes of EfsB, 72 patients with CIED and monomicrobial EfsB were identified. Five of these patients were diagnosed with IE (7%), three of whom had echocardiographic changes on the CIED. Four CIED were extracted (6%). Recurrences were found in seven of 68 patients (10%) not subjected to extraction and in none of the extracted. In the group of patients without extraction, community acquisition and predisposition for IE were significantly associated with recurrent infection in univariate analyses. No infections involving the CIED were diagnosed during the recurrences. Conclusions: In patient with monomicrobial EfsB, it seems safe to omit extraction if no structural changes are found on the CIED.

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author
; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Bacteremia, CIED extraction, Endocarditis, Enterococcus faecalis, Recurrent infection
in
Infection
volume
50
issue
6
pages
7 pages
publisher
Springer
external identifiers
  • pmid:35538390
  • scopus:85129736286
ISSN
0300-8126
DOI
10.1007/s15010-022-01838-3
language
English
LU publication?
yes
id
6631eae8-321a-4033-acc5-3d0860a15d36
date added to LUP
2023-01-20 14:09:16
date last changed
2024-09-20 08:37:59
@article{6631eae8-321a-4033-acc5-3d0860a15d36,
  abstract     = {{<p>Purpose: In all patients with cardiac implantable electronic devices (CIED) and Enterococcus faecalis bacteremia (EfsB), endocarditis (IE) and CIED infection should be suspected. Guidelines recommend extraction of the CIED when CIED infection or IE is diagnosed. Whether extraction of the CIED should be done in other situations with EfsB is not known. We aimed to describe the management and outcome of patients with CIED and monomicrobial EfsB, in relation to extraction and recurrent EfsB. Methods: A population-based cohort of patients with monomicrobial EfsB from January 2014 to November 2020 was identified through microbiology registers in the Region Skåne, Sweden. Data on CIED and other clinical features were collected from medical records. Results: Among 1087 episodes of EfsB, 72 patients with CIED and monomicrobial EfsB were identified. Five of these patients were diagnosed with IE (7%), three of whom had echocardiographic changes on the CIED. Four CIED were extracted (6%). Recurrences were found in seven of 68 patients (10%) not subjected to extraction and in none of the extracted. In the group of patients without extraction, community acquisition and predisposition for IE were significantly associated with recurrent infection in univariate analyses. No infections involving the CIED were diagnosed during the recurrences. Conclusions: In patient with monomicrobial EfsB, it seems safe to omit extraction if no structural changes are found on the CIED.</p>}},
  author       = {{Berge, Andreas and Arkel, Ludvig and Nilson, Bo and Rasmussen, Magnus}},
  issn         = {{0300-8126}},
  keywords     = {{Bacteremia; CIED extraction; Endocarditis; Enterococcus faecalis; Recurrent infection}},
  language     = {{eng}},
  number       = {{6}},
  pages        = {{1517--1523}},
  publisher    = {{Springer}},
  series       = {{Infection}},
  title        = {{Enterococcus faecalis bacteremia, cardiac implantable electronic device, extraction, and the risk of recurrence}},
  url          = {{http://dx.doi.org/10.1007/s15010-022-01838-3}},
  doi          = {{10.1007/s15010-022-01838-3}},
  volume       = {{50}},
  year         = {{2022}},
}