Abstract 15982: Management and Follow-Up of Inpatients With Cardiac Implantable Electronic Devices and Bacteremia With and Without Electrophysiology Consultation

Abstract

Introduction: Transvenous cardiac implantable electronic device (CIED) infection is a significant cause of morbidity and mortality. Expert consensus recommends a multidisciplinary approach to bacteremia in the context of CIED incorporating both infectious disease (ID) and electrophysiology (EP) consultation to balance the risks of infection with those of CIED removal. Hypothesis: Not all patients with CIEDs and bacteremia are evaluated with EP consultation, and this difference is associated with variability in management. Methods: Using the EMR, we retrospectively identified inpatients with a CIED and a positive blood culture across three hospitals: one academic, one specialty and one community. True infection versus contaminant was determined by an EP or ID attending at the time of presentation or adjudicated retrospectively by an EP who performs extractions. We examined the rates of EP consultation based on hospital site, CIED removal and appropriate follow-up in those without CIED removal. Fisher’s exact test was used to compare the rates of follow up. Results: We identified 88 inpatients with a CIED and positive blood culture between January 2020 - February 2023. True bacteremia was adjudicated in 48 patients (55%). Of these patients, 24 were seen by EP (50%), 22 were seen by EP and ID (46%), and 14 were seen by neither (29%). Patients admitted to an academic hospital were more likely to be seen by EP (22/38, 57%) than those admitted to a specialty or community hospital (2/10, 20%). CIED removal was performed in 15 of 24 patients seen by EP (63%). Patients seen by EP were significantly more likely to have documented plans, repeat blood cultures after antibiotic completion, and appropriate follow up than those not seen by EP (24/24 100% vs. 3/24, 8%, p<0.001). Conclusion: Even at a high-volume extraction center, EP consultation for patients with true bacteremia in the context of CIED only occurred 50% of the time. Patients admitted to an academic hospital were more likely to be seen by EP than at a community or subspecialty hospital. EP consultation is important for all bacteremic patients with CIEDs, not only to recommend extraction if appropriate, but also to ensure timely follow-up and management of treatment failure, consistent with expert consensus.