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

BACKGROUND: In case of Staphylococcus aureus bacteremia (SAB), complete cardiac implantable electronic device (CIED) removal is advised by the European Heart Rhythm Association. OBJECTIVES: The objective of the study was to estimate clinical outcomes after SAB in the Danish CIED carriers. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.