Staphylococcus bacteremia without evidence of a cardiac implantable electronic device infection

Abstract Background Staphylococcus bacteremia (SB) in the presence of a cardiac implantable electronic device (CIED) is frequently associated with CIED infection. In patients without clear CIED infection but SB, the role for empiric CIED removal is unclear. Objective Describe the natural history of SB in the setting of a CIED and the impact of CIED removal on mortality in patients with concurrent SB without evidence of CIED infection. Methods Three hundred sixty consecutive patients (61±17 years, 71% male, 92% Staphylococcus aureus) with CIEDs and concurrent SB were reviewed. Results At the initial presentation with SB, 178 patients had no evidence of CIED infection. Of these, 132 (74%) had another identified source of infection. Of the 178 patients without CIED infection, 18 (10%) had empiric CIED removal during the initial bacteremia. Among those who did not undergo CIED removal, SB subsequently relapsed in 19% and relapse rates were not different for those with or without another identifiable source at initial presentation. Relapse was strongly associated with duration of SB >1-day (odds ratio, 9.99; 95% confidence interval [CI] 3.24-30.86). Despite absence of CIED infection, one-year mortality was 35% and empiric device removal during the initial presentation was associated with survival benefit (hazard ratio 0.28, 95% CI 0.08-0.95). Conclusion For patients with SB without evidence of CIED infection, relapse is predicted by the duration of bacteremia. Empiric CIED removal appears to be associated with a survival benefit, although there are likely clinical situations in which this could be deferred.