Article Impact Level: HIGH Data Quality: STRONG Summary of European Heart Journal, 45(14), 1269–1277. https://doi.org/10.1093/eurheartj/ehae127 Dr. Tardu Özkartal et al.
Points
- The study investigated the diagnostic approach, treatment, and outcomes of ICD/CRT-D patients hospitalized with bloodstream infection (BSI).
- The single-center retrospective cohort analysis included 515 consecutive ICD/CRT-D patients implanted between 2012 and 2021.
- Most BSI cases (92%) led to hospitalization in non-cardiology units, with 53% of episodes lacking cardiac imaging, highlighting potential diagnostic gaps.
- While 85% of patients received short-term antibiotics, chronic antibiotic suppression therapy and system extraction were less common.
- Patients with BSI exhibited a nearly seven-fold higher rate of all-cause mortality, emphasizing the need for enhanced interdisciplinary collaboration and greater utilization of cardiac imaging for timely diagnosis and appropriate treatment.
Summary
The research aimed to investigate the diagnostic approach, treatment, and outcomes of patients with implantable cardioverter defibrillators (ICD) and cardiac resynchronization therapy and defibrillator (CRT-D) hospitalized with bloodstream infection (BSI). The single-center retrospective cohort analysis study included 515 consecutive ICD/CRT-D patients implanted between 2012 and 2021. Over a median follow-up of 59 months, 47 BSI episodes occurred in 36 patients, with the majority of BSI cases (92%) leading to hospitalization in non-cardiology units. Notably, in 53% of the episodes, no cardiac imaging was performed, highlighting potential gaps in the diagnostic workup of these patients.
The findings revealed that while nearly all patients (85%) received short-term antibiotics, chronic antibiotic suppression therapy (n = 4) and system extraction (n = 3) were less common. Importantly, patients with BSI exhibited a nearly seven-fold higher rate of all-cause mortality, emphasizing the significant impact of BSI on patient outcomes. The study underscored the insufficiency of the diagnostic workup for defibrillator patients with BSI admitted to non-cardiology units, particularly in characterizing lead-related endocarditis. The high mortality rate in these patients was attributed to potential underdiagnosis and the subsequent delay or absence of system removal, highlighting the critical need for an interdisciplinary approach and increased utilization of cardiac imaging for timely diagnosis and appropriate treatment.
The research shed light on the challenges in diagnosing and managing BSI in ICD/CRT-D patients, particularly when admitted to non-cardiology units. The study’s findings underscored the imperative for enhanced interdisciplinary collaboration and greater utilization of cardiac imaging to facilitate timely diagnosis and improve the management of BSI in this patient population.
Link to the article: https://academic.oup.com/eurheartj/article/45/14/1269/7636623
References Özkartal, T., Demarchi, A., Conte, G., Pongan, D., Klersy, C., Caputo, M. L., Bergonti, M., Bernasconi, E., Gaia, V., Granger, C. B., & Auricchio, A. (2024). Cardiac implantable electronic devices and bloodstream infections: Management and outcomes. European Heart Journal, 45(14), 1269–1277. https://doi.org/10.1093/eurheartj/ehae127
