Bacteraemia and fungemia in patients with cardiac implantable electronic devices: A retrospective cohort study

The risk of cardiac implantable electronic device (CIED) infection in the setting of any bloodstream infection (BSI) is unclear. Previous studies have mainly focused on Staphylococcus aureus. The aim of this study is to evaluate the risk of CIED infection and the outcome during BSIs caused by any pathogen. All positive blood culture results of patients with a CIED implantation or modification procedure between January 2013 and September 2021 in Tampere Heart Hospital occurring after the recorded procedure date until September 30th 2022 were identified. The primary outcome was the occurrence of a CIED infection within 90 days from the onset of BSI, defined according to the 2019 International CIED Infection Criteria. Secondary outcomes were all-cause death and recurrence of BSI. The study included 630 BSIs with 16 CIED infections (incidence 2.5 %) during the follow-up period. The bacteraemias were most commonly caused by Escherichia coli (161 cases, 26 %) and Staphylococcus aureus (132 cases, 21 %). The risk of CIED infection was highest with staphylococcal bacteraemia (8.2 %) and lowest with gram-negative bacteria (0.4 %). CIED removal did not influence the overall mortality (P = 0.14) or the recurrence of bacteraemia: recurrence occurred in 14 % of the cases (2/14) if the CIED was removed and in 4 % (25/616) if it was not. The risk of CIED infection associated with BSI was generally low, but dependent on the causing pathogen. The occurrence of BSI in a patient with CIED does not automatically warrant removal of the CIED.