453. Shorter Duration of Antimicrobial Therapy is Noninferior for Cardiovascular Implantable Electronic Device Associated Systemic Infections

TL;DR

Shorter antibiotic treatment after device removal for heart infections is just as effective as longer treatment in preventing death or infection recurrence.

Contribution

This is the first study to show that shorter antibiotic duration after device extraction is noninferior to longer treatment for infection outcomes.

Findings

No significant difference in 90-day mortality between shorter and longer antibiotic groups.

Recurrence rates of bacteremia were similar between the two treatment durations.

Relapses were linked to high-risk bacteria like Staphylococcus aureus and Serratia sp.

Abstract

Cardiovascular implantable electronic device (CIED) associated infection is the most common indication for lead extraction. While the need for complete device removal is well established, this study is the first to examine the impact of antimicrobial duration on clinical outcomes.Figure 1:Overall Survival Post-CIED Lead Extraction Stratified by Duration of Antibiotic Therapy

Overall Survival Post-CIED Lead Extraction Stratified by Duration of Antibiotic Therapy

We reviewed all patients who underwent CIED lead extraction at our institution between June 2013 and December 2023. Patients who had extraction for a primary indication of bacteremia or lead-associated vegetation were included. Duration of antibiotics prescribed was stratified by initial decision to treat, ≤ 2 weeks or > 2 weeks post-extraction. Measured outcomes were all-cause mortality at 90 days, rates of recurrence or relapse of bacteremia from the same organism, infectious complications, and post-operative disposition to intensive care unit (ICU).

Of 747 patients reviewed, 79 cases met inclusion criteria. Baseline characteristics were very similar between cohorts. Median duration of antibiotic therapy was 12.6 and 38.6 days, respectively. Kaplan-Meier survival analysis showed no significant difference in survival (p= 0.438, HR 0.693, 95% CI 0.085-5.652). There was no difference in rates of recurrent bacteremia (7% vs 6%, p=0.952), infectious complications (27% vs 30%, p=0.817), hospital length of stay (mean 9.9 vs 13.3, p=0.360), post-operative ICU disposition (0% vs 17%, p=0.112), and rates of cardiac arrest (7% vs 5%, p=0.577) between patients who were prescribed ≤ 2 weeks of antibiotics versus > 2 weeks of antibiotics, respectively. Relapse or recurrence was seen in 5 patients, all of whom had Staphylococcus aureus (n=3) or Serratia sp. (n=2) and either an LVAD or valve replacement.

Shorter durations (≤ 2 weeks) of antimicrobial therapy after CEID lead extraction was not associated with increased mortality or higher rate of recurrent bacteremia. Among the few patients that experienced relapse or recurrence in both groups, all were associated with high-risk organisms for secondary seeding of other cardiovascular prostheses. Larger studies are needed to define optimal antibiotic duration and determine risk factors for recurrent bacteremia in this population.

All Authors: No reported disclosures

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