Infectious Diseases Department, Hospital Universitari Mútua de Terrassa, Plaza Dr. Robert 5, Terrassa, Barcelona 08021, Spain; Universitat Internacional de Catalunya, Barcelona, Spain.
Infectious Diseases Department, Hospital Universitari Mútua de Terrassa, Plaza Dr. Robert 5, Terrassa, Barcelona 08021, Spain.
J Infect. 2022 Aug;85(2):123-129. doi: 10.1016/j.jinf.2022.05.022. Epub 2022 May 23.
To determine the incidence of cardiac device-related infection (CDRI) among patients with cardiac device (CD) during late-onset bloodstream infection (BSI) and to identify the risk factors associated with CDRI.
Patients with a CD (cardiac implantable electronic devices -CIED- and/or prosthetic heart valve -PHV-) and late-onset-BSI (>1 year after the CD implantation/last manipulation) were selected from the PROBAC project, a prospective, observational cohort study including adult patients with bacteraemia consecutively admitted to 26 Spanish hospitals from October 2016 to March 2017. Multivariate analyses using logistic regression were performed to identify the risk factors associated with CDRI.
317 BSI from patients carrying a CD were registered, 187 (56.2%) were late-onset-BSI. A total of 40 (21.4%) CDRI were identified during late-onset-BSI. The CDRI cumulative incidence in Gram-positive-BSI was 41.8% (38/91), with S. aureus, Enterococcus spp. and viridans streptococci showing the greatest percentages: 40% (12/30), 42% (11/26) and 75% (6/8), respectively. Independent predictors of CDRI were an unknown source of infection (OR: 2.88 [CI 95%:1.18-7.06], p = 0.02), Gram-positive-aetiology (23.1 [5.23-102.1], p < 0.001) and persistent bacteraemia (4.81 [1.21-19], p = 0.03). In an exploratory analysis, S. aureus (3.99 [1.37-11.65], p = 0.011), Enterococcus spp. (5.21 [1.76-15.4], p = 0.003) and viridans streptococci (28.7 [4.71-173.5], p < 0.001) aetiology were also found to be risk factors for CDRI.
CDRI during late-onset-BSI is a frequent phenomenon. Risk of CDRI differs among species, happening in almost half of the Gram-positive-BSI. An unknown source of the primary infection, Gram-positive-aetiology -especially S. aureus, Enterococcus spp. and viridans streptococci-, and persistent bacteraemia were identified as risk factors for CDRI.
确定心脏装置（CD）相关感染（CDRI）在晚期血流感染（BSI）患者中的发生率，并确定与 CDRI 相关的危险因素。
从 PROBAC 项目中选择携带 CD（心脏植入式电子设备-CIED-和/或人工心脏瓣膜-PHV-）且发生晚期 BSI（CD 植入/最后一次操作后>1 年）的患者。对 2016 年 10 月至 2017 年 3 月期间连续入住西班牙 26 家医院的成年菌血症患者进行前瞻性观察队列研究。采用 logistic 回归进行多变量分析，以确定与 CDRI 相关的危险因素。
登记了 317 例携带 CD 的 BSI，其中 187 例（56.2%）为晚期 BSI。在晚期 BSI 中发现了 40 例（21.4%）CDRI。革兰阳性菌 BSI 中 CDRI 的累积发生率为 41.8%（38/91），金黄色葡萄球菌、肠球菌属和草绿色链球菌的比例最大：40%（12/30）、42%（11/26）和 75%（6/8）。CDRI 的独立预测因素是感染源不明（OR：2.88 [95%CI 1.18-7.06]，p=0.02）、革兰阳性菌病因（23.1 [5.23-102.1]，p<0.001）和持续性菌血症（4.81 [1.21-19]，p=0.03）。在一项探索性分析中，还发现金黄色葡萄球菌（3.99 [1.37-11.65]，p=0.011）、肠球菌属（5.21 [1.76-15.4]，p=0.003）和草绿色链球菌（28.7 [4.71-173.5]，p<0.001）病因也是 CDRI 的危险因素。
晚期 BSI 期间 CDRI 是一种常见现象。CDRI 的风险因物种而异，在近一半的革兰阳性菌 BSI 中发生。原发性感染的不明来源、革兰阳性菌病因（尤其是金黄色葡萄球菌、肠球菌属和草绿色链球菌）和持续性菌血症被确定为 CDRI 的危险因素。
