ArticleTherapeutic advances in infectious disease
Duration of antimicrobial therapy in cardiovascular implantable electronic device associated systemic infections: a retrospective analysis.
Article in Therapeutic advances in infectious disease. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
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, 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.
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