Risk factors for Gram-negative bacterial infection of cardiovascular implantable electronic devices: multicentre observational study (CarDINe Study).
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Pascale Renato, Toschi Alice, Aslan Abdullah Tarik, Massaro Giulia, Maccaro Angelo, Fabbricatore Davide, Dell'Aquila Andrea, Ripa Marco, Işık Mehmet Emirhan, Kızmaz Yeşim Uygun, Iacopino Saverio, Camici Marta, Perna Francesco, Akinosoglou Karolina, Karruli Arta, Papadimitriou-Olivgeris Matthaios, Kayaaslan Bircan, Bilir Yeşim Aybar, Evren Özcan Emin, Turan Oğuzhan Ekrem, Işık Muhammed Cihan, Pérez-Rodríguez María Teresa, Yagüe Belén Loeches, Quirós Alejandro Martín, Yılmaz Mesut, Petersdorf Sabine, De Potter Tom, Durante-Mangoni Emanuele, Akova Murat, Curnis Antonio, Gibertoni Dino, Diemberger Igor, Scudeller Luigia, Viale Pierluigi, Giannella Maddalena, CarDINe Study Group
Аннотация
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.