Background and Aims Bloodstream infection (BSI) of any cause may lead to device infection in cardiac implantable electronic device (CIED) patients. Aiming for a better understanding of the diagnostic approach, treatment, and outcome, patients with an implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy and defibrillator (CRT-D) hospitalized with BSI were investigated. Methods This is a single-centre, retrospective, cohort analysis including consecutive ICD/CRT-D patients implanted between 2012 and 2021. These patients were screened against a list of all hospitalized patients having positive blood cultures consistent with diagnosed infection in any department of a local public hospital. Results The total cohort consisted of 515 patients. Over a median follow-up of 59 months (interquartile range 31–87 months), there were 47 BSI episodes in 36 patients. The majority of patients with BSI (92%) was admitted to non-cardiology units, and in 25 episodes (53%), no cardiac imaging was performed. Nearly all patients (85%) were treated with short-term antibiotics, whereas chronic antibiotic suppression therapy (n = 4) and system extraction (n = 3) were less frequent. Patients with BSI had a nearly seven-fold higher rate (hazard ratio 6.7, 95% confidence interval 3.9–11.2; P < .001) of all-cause mortality. Conclusions Diagnostic workup of defibrillator patients with BSI admitted to a non-cardiology unit is often insufficient to characterize lead-related endocarditis. The high mortality rate in these patients with BSI may relate to underdiagnosis and consequently late/absence of system removal. Efforts to increase an interdisciplinary approach and greater use of cardiac imaging are necessary for timely diagnosis and adequate treatment.

中文翻译：

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心脏植入电子设备和血流感染：管理和结果

背景和目的任何原因的血流感染（BSI）都可能导致心脏植入电子设备（CIED）患者的设备感染。为了更好地了解诊断方法、治疗和结果，对因 BSI 住院且使用植入式心律转复除颤器 (ICD) 和心脏再同步治疗和除颤器 (CRT-D) 的患者进行了调查。方法 这是一项单中心、回顾性、队列分析，包括 2012 年至 2021 年间连续植入的 ICD/CRT-D 患者。这些患者根据所有住院患者的名单进行筛选，这些患者的血培养呈阳性，与医院任何科室诊断的感染一致。当地公立医院。结果 总队列由 515 名患者组成。在中位随访 59 个月（四分位数范围 31-87 个月）中，36 名患者出现了 47 次 BSI 发作。大多数 BSI 患者 (92%) 被送往非心脏病科单位，其中 25 例 (53%) 没有进行心脏成像。几乎所有患者 (85%) 均接受短期抗生素治疗，而长期抗生素抑制治疗 (n = 4) 和系统拔除 (n = 3) 的频率较低。 BSI 患者的全因死亡率高出近七倍（风险比 6.7，95% 置信区间 3.9–11.2；P < .001）。结论 对非心脏病科室收治的除颤 BSI 患者进行的诊断检查通常不足以表征铅相关心内膜炎。这些 BSI 患者的高死亡率可能与诊断不足以及因此延迟/未移除系统有关。为了及时诊断和充分治疗，有必要努力增加跨学科方法和更多地使用心脏成像。