Infectious Diseases Unit, Department of Integrated Management of Infectious Risk, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
Infectious Diseases Unit, Department of Integrated Management of Infectious Risk, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
Int J Antimicrob Agents. 2023 Mar;61(3):106734. doi: 10.1016/j.ijantimicag.2023.106734. Epub 2023 Jan 21.
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.
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.
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).
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.
心血管植入电子设备（CIED）感染主要由革兰阳性菌（GPB）引起。关于革兰阴性菌 CIED（GNB-CIED）感染的数据有限。本研究旨在探讨 GNB-CIED 感染患者的危险因素、临床和诊断特征及转归。
这是一项多中心、国际性、回顾性、病例对照对照研究，纳入 2015 年至 2019 年期间在欧洲 17 个中心接受 CIED 植入的患者。对每位诊断为 GNB-CIED 的患者，选择 1 例 GPB-CIED 感染匹配对照和 2 例无感染匹配对照。
共纳入 236 例患者：59 例 GNB-CIED 感染，59 例 GPB-CIED 感染，118 例无感染。三组间临床表型、诊断和治疗管理无差异。GNB 组氟脱氧葡萄糖正电子发射断层扫描（FDG PET/CT）阳性率高于 GPB-CIED 感染组（85.7% vs. 66.7%；P=0.208），但无统计学差异。GNB-CIED 感染的危险因素包括Charlson 合并症指数评分（相对风险降低，RRR=1.211；P=0.011）、肥胖（RRR=5.122；P=0.008）、心室起搏/心室感知抑制反应起搏器植入（RRR=3.027；P=0.006）和右锁骨下静脉植入部位（RRR=5.014；P=0.004）。180 天生存分析显示，GNB-CIED 感染与死亡风险增加相关（HR=1.842；P=0.067）。
肥胖、合并症数量多和右锁骨下静脉植入部位与 GNB-CIED 感染风险增加相关。鉴于该组患者的预后较差，建议对 GNB-CIED 感染患者进行早期积极的治疗干预，该干预可能需要通过 FDG PET/CT 来指导。
