Infections of cardiovascular implantable electronic devices: 14 years of experience in an Italian hospital

The aim of the study was to describe the microbial aetiology of infections from cardiovascular implantable electronic devices (CIEDs) between 2001 and 2014 at The Centro Cuore Morgagni Hospital (Catania, Italy). In this 14-year retrospective study on pacemaker isolates 1,366 patients were evaluated and clinical data were collected. CIEDs were analyzed and isolates tested by routine microbiological techniques. The presence of bacterial biofilm was assessed by means of scanning electron microscopy. Of the patients, fifty-three had catheter-related infections (3.9%), mainly resulting from Staphylococci (4 S. aureus, 32 S. epidermidis, 15 S. hominis, 3 S. haemolyticus, 1 S. warnerii, 1 S. schleiferi, 1 S. lentus and 1 S. capitis) that covered the cardiac catheter SummaRY with biofilm. Overall, oxacillin-resistance was 55.1%, especially among S. epidermidis, while all isolates were susceptible to vancomycin, teicoplanin, tigecyclin, rifampin, trimethoprim/sulfamethoxazole, linezolid, moxifloxacin, tobramycin and gentamicin. Coagulase- negative staphylococci were the most frequently isolated and S. epidermidis was largely the main single agent. Only four Gram negatives caused polymicrobial infections with Staphylococci. Despite improvements in CIED design and implantation techniques, infection of cardiac devices remains a serious problem.