Incidence of Staphylococcus aureus Bacteremia in Patients Following Implantation of Cardiac Implantable Electronic Devices: A Danish Nationwide Cohort Study

Kasper Høtoft Bengtsen; Alexander Christian Falkentoft; Melanie Vuong Le; Ketil Haugan; Berit Thornvig Philbert; Jens Brock Johansen; Christian Torp-Pedersen; Sam Riahi; Jens Cosedis Nielsen; Charlotte Larroudé; Andreas Petersen; Anders Rhod Larsen; Lauge Østergaard; Emil Fosbøl; Niels Eske Bruun; Anne-Christine Ruwald

doi:10.1093/ofid/ofae515

Incidence of Staphylococcus aureus Bacteremia in Patients Following Implantation of Cardiac Implantable Electronic Devices: A Danish Nationwide Cohort Study

Open Forum Infect Dis. 2024 Sep 9;11(9):ofae515. doi: 10.1093/ofid/ofae515. eCollection 2024 Sep.

Authors

Kasper Høtoft Bengtsen¹, Alexander Christian Falkentoft¹, Melanie Vuong Le¹, Ketil Haugan¹, Berit Thornvig Philbert², Jens Brock Johansen³, Christian Torp-Pedersen⁴, Sam Riahi⁵, Jens Cosedis Nielsen⁶, Charlotte Larroudé⁷, Andreas Petersen⁸, Anders Rhod Larsen⁸, Lauge Østergaard², Emil Fosbøl², Niels Eske Bruun¹, Anne-Christine Ruwald^{1

2}

Affiliations

¹ Department of Cardiology, Zealand University Hospital, Roskilde, Denmark.
² Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
³ Department of Cardiology, Odense University Hospital, Odense, Denmark.
⁴ Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark.
⁵ Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
⁶ Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
⁷ Department of Cardiology, Herlev and Gentofte University Hospital, Copenhagen, Denmark.
⁸ Department of Bacteria, Fungi and Parasites, National Reference Laboratory for Antimicrobial Resistance, Statens Serum Institut, Copenhagen, Denmark.

Abstract

Background: Staphylococcus aureus bacteremia (SAB) is a high-risk condition associated with high morbidity and mortality. In the presence of cardiac implantable electronic devices (CIEDs), SAB may cause or clinically indicate device infection. We aimed to estimate the 10-year absolute risk of SAB in adult Danish first-time CIED carriers. Secondary aims included identification of risk factors associated with SAB.

Methods: A registry-based study utilizing Danish nationwide registers and including consecutive Danish patients undergoing first CIED implantation between 2000 and 2020 was conducted. The primary outcome was first-time SAB after CIED implantation.

Results: A total of 87 257 patients with first CIED implantation in the study period were identified (median age, 75 years; 62.6% were male; median follow-up, 3.8 years). Patients with pacemakers (PMs) were older and with more noncardiovascular comorbidities compared to patients with implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy devices with or without defibrillator capacity (CRTs). In total, 1366 patients (1.6%) developed SAB. The 10-year absolute risk (95% confidence interval) of SAB was 2.0% (1.9%-2.1%) for PM, 2.6% (2.2%-3.1%) for ICD, and 3.7% (3.0%-4.5%) for CRT. A multivariable Cox analysis identified hemodialysis (hazard ratio [HR], 8.51), SAB before CIED (HR, 2.76), liver disease (HR, 2.35), and carrying a CRT device (HR, 1.68) among the covariates associated with increased risk of SAB.

Conclusions: The absolute risk of SAB in Danish CIED carriers increased with more advanced CIED systems. The risk was highest within the first 3 months after CIED implantation and increased with the presence of certain covariates including renal dialysis, SAB before CIED, male sex, and advancing age.

Keywords: CIED; Cardiac resynchronization therapy; Implantable cardioverter defibrillator; Pacemaker; Staphylococcus aureus bacteremia.