Duration of antimicrobial therapy in cardiovascular implantable electronic device associated systemic infections: a retrospective analysis.

BACKGROUND

While the need for complete device removal is well-established for cardiovascular implantable electronic device (CIED) infections, there is insufficient evidence on the optimal duration of antimicrobial therapy.

OBJECTIVES

To examine how antimicrobial duration affects clinical outcomes of patients presenting with CIED-associated bacteremia and lead endocarditis.

DESIGN

This is a retrospective cohort study conducted at a quaternary care hospital in Houston, TX, USA.

METHODS

Patients who underwent device removal for a primary indication of bacteremia or lead endocarditis over a 10-year period were stratified by prescribed duration of antibiotics as ⩽2 weeks or >2 weeks post-extraction. Measured outcomes included all-cause mortality at 90 days, recurrent bacteremia, infectious complications, and hospital length of stay.

RESULTS

Of 747 patients who underwent lead extraction at Baylor St. Luke's Medical Center between June 2013 and December 2023, 79 cases met the inclusion criteria. Baseline characteristics were similar between cohorts. Mean duration of antibiotics prescription was 12.6 versus 38.6 days. There was no observed difference in survival (HR 0.693, 95% CI 0.085-5.652, p = 0.438), recurrent bacteremia (7% vs 6%, p = 0.952), infectious complications (27% vs 30%, p = 0.817), and hospital length of stay (mean 9.9 vs 13.3, p = 0.360) between the ⩽2 weeks and >2 weeks cohort, respectively. Five patients had recurrence, all of whom had bacteremia from Staphylococcus aureus or Serratia sp. and an underlying left ventricular assist device or valve replacement.

CONCLUSION

Shorter duration of antibiotics after complete CIED removal had similar rates of mortality or recurrent bacteremia. Recurrence was associated with bacteremia from high-risk organisms with potential for secondary seeding of other cardiovascular prostheses. Larger prospective studies are needed to explore these findings.