Among 56 CIED patients with Staphylococcus aureus bacteraemia, 30-day mortality was 40%, and full system extraction was associated with longer median survival compared to no extraction (66 vs 45 months).
Cohort (n=56)
Does full system CIED extraction improve survival in CIED patients with Staphylococcus aureus bacteraemia?
In a real-world cohort of CIED patients with S. aureus bacteremia, mortality is high and guideline-directed investigations and lead extraction are underutilized, despite extraction being associated with longer survival.
Abstract Background Infection associated with cardiac implantable electronic devices (CIED) confers significant mortality.1 Suspicion of CIED-associated infective endocarditis (IE) should be high in Staphylococcus aureus bacteraemia (SAB)2, with rates of 30-50%.2-5 When CIED-related IE is suspected, guidelines6 recommend undertaking transthoracic echocardiography (TTE), transoesophageal echocardiography (TOE) and 18FFDG-PET/CT (or WBC-SPECT) (Class I recommendations). Full system CIED extraction (FSCE) is associated with reduced mortality and recommended (Class I) when confirmed CIED involvement, and should be considered (Class IIa) in probable isolated valvular IE. Purpose Describe management and outcomes in a real-world cohort of SAB-CIED patients. Method Identified all regional cases (population 1.4 million) of SAB from 1st January 2018 to 31st December 2021. Patients screened for CIED - this group formed our cohort. Demographics, investigations, management, and outcomes obtained from electronic health records. Survival times calculated from date of SAB diagnosis. Guideline-directed diagnostic criteria6 for IE and CIED-IE calculated from available data. We further subcategorised this diagnostic label by whether the patient had undergone complete guideline recommended investigations, although we only included patients surviving 7 days in this analysis. Result We identified 56 CIED-SAB patients from 1098 SAB patients. Median age 77(+/- 13)years; 19(34%) were female. CIEDs were pacemaker, transvenous ICD, CRT in 41(73%), 7(13%), 8(14%) patients respectively, with median dwell time of 47(+/-193)months. Minimum follow-up 37 months, and vital status of all patients known at analysis. 46(82%) could already be classified as ‘possible IE’ before imaging investigations were undertaken. 48(86%) patients survived 7 days following SAB diagnosis. Investigations included TTE, TOE, PET/WCS in 44(92%), 14(29%), 9(19%) patients respectively. The commonest final diagnosis was ‘possible IE - incompletely investigated’(38, 79%). The final diagnosis was ‘definite IE’ following complete 6(13%) or incomplete investigations 2(4%). 4(8%) patients categorised as ‘IE excluded’ following complete investigation. Median survival across all 56 patients was 276days (+/-534) with 30-day mortality of 40%. 27(52%) survived to hospital discharge: 4(15%) managed with FSCE, and 23(85%) without FSCE. Median age and survival in the FSCE and non-FSCE groups were 70(+/- 8) years and 66(+/- 11) months, and 68(+/- 15) years and 45(+/- 26) months. All FSCE patients alive at analysis. Conclusion Inpatient and 30-day mortality is high amongst real-world SAB-CIED patients. The majority meet diagnostic criteria for ‘possible IE’ before imaging investigations, although most patients were incompletely investigated, and final diagnosis might have been revised by guideline-indicated investigations. FSCE utilisation was low, although FSCE was associated with longer survival.
Latter et al. (2025) conducted a cohort in Staphylococcus aureus bacteraemia in patients with cardiac implantable electronic devices (CIED) (n=56). Full system CIED extraction (FSCE) vs. Management without FSCE was evaluated on Median survival. Among 56 CIED patients with Staphylococcus aureus bacteraemia, 30-day mortality was 40%, and full system extraction was associated with longer median survival compared to no extraction (66 vs 45 months).