# Device-Removal, Reinfection, and Mortality After Staphylococcus aureus Bacteremia in Patients With Cardiac Implantable Electronic Devices

## TL;DR

This study examines outcomes of Staphylococcus aureus bacteremia in patients with cardiac devices, finding that device removal is linked to lower reinfection and mortality.

## Contribution

The study provides real-world evidence on the impact of device removal in CIED patients with SAB in a nationwide cohort.

## Key findings

- CIED patients with SAB had slightly higher 30-day mortality than controls.
- Device removal within 30 days was associated with lower reinfection and mortality rates.
- Only 15.8% of CIED patients underwent device removal after SAB diagnosis.

## Abstract

In case of Staphylococcus aureus bacteremia (SAB), complete cardiac implantable electronic device (CIED) removal is advised by the European Heart Rhythm Association.

The objective of the study was to estimate clinical outcomes after SAB in the Danish CIED carriers.

We conducted a nationwide register-based cohort study including all patients with SAB after CIED implantation between 2000 and 2020. Cumulative incidence of device removal, SAB reinfection, and all-cause mortality were estimated and compared to sex and age-matched non-CIED controls with SAB. Landmark analysis at the time of hospital discharge estimating mortality and reinfection according to CIED removal status in surviving patients was conducted.

In total, 1,816 patients with CIED and SAB and 9,080 matched controls were included in the study (median age 77.5 years, 73.0% males). Thirty-day all-cause mortality was 34.0% (95% CI: 31.8%-36.2%) in patients with CIED and 31.0% (95% CI: 30.0%-31.9%) in controls (P = 0.019, adjusted HR: 1.11 [95% CI: 1.02-1.22]). Device removal within 30 days was performed in 286 patients (15.8%). The landmark analysis showed significantly lower 180-days cumulative incidence of SAB reinfection and all-cause mortality in patients undergoing device removal compared to those with retained CIEDs (reinfection: 2.5% vs 5.5%; mortality: 7.8% vs 31.2%). Patients who underwent CIED removal were younger and had less comorbidity compared to those with retained CIEDs.

The Danish CIED carriers had slightly higher 30-day all-cause mortality after SAB compared to matched controls. Only a minor selected proportion underwent device removal after SAB diagnosis and, after initial survival, these patients had lower 180-days reinfection rates and mortality compared to patients with retained devices.