Evaluation of EHRA Consensus in Patients with Cardiovascular Implantable Electronic Devices and Staphylococcus aureus Bacteremia.

Cardiovascular implantable electronic device (CIED) implantation has markedly increased over the past two decades. Staphylococcus aureus bacteremia (SAB) occurs in patients with CIED and determination of device infection is often difficult.To examine the rate and clinical characteristics of SAB in patients living with CIED using 2019 European Heart Rhythm Association (EHRA) International Consensus Document.We conducted a retrospective study of patients with CIED who were hospitalized at Mayo Clinic, Rochester, with SAB from 2012 to 2019. Patients who met CIED infection criteria following SAB based on EHRA criteria were identified. A descriptive statistic and time-dependent Cox model were used.Overall, 110 patients with CIED developed SAB and 92 (83.6%) of them underwent transesophageal echocardiogram (TEE). Fifty-seven (51.8%) and 31 (28.2%) patients met criteria for definite and possible CIED infections, respectively. At 30-day follow-up, the cumulative rate of patients undergoing complete device extraction was 80.0% in the definite CIED infection group, compared with 35.5% and 27.3% in the possible and rejected CIED infection groups, respectively. We found that the CIED extraction was associated with an 83% reduction in risk of one-year mortality in the definite CIED infection group.The rate of CIED infections following SAB was higher than that reported previously. Increased use of TEE and a novel case definition with broader diagnostic criteria were likely operative, in part, in accounting for the higher rate of CIED infections complicating SAB. Complete device removal is critical in patients with definite CIED infection to improve one-year mortality.