Abstract 20081: Predicting Risk of Endovascular Device Infection in Patients with Staphylococcus aureus Bacteremia

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Muhammad Sohail ◽  
Bharath Raj Palraj ◽  
Sana Khalid ◽  
Daniel Uslan ◽  
Farah Al-Saffar ◽  
...  
Keyword(s):  
Electronic Device ◽  
Clinical Signs ◽  
Infection Model ◽  
Multivariable Model ◽  
Operating Characteristics ◽  
Clinical Predictors ◽  
Staphylococcus Aureus Bacteremia ◽  
Increased Risk ◽  
Device Infection ◽  
Device Extraction

Objectives: Clinicians need to identify which patients presenting with S. aureus bacteremia (SAB) have underlying cardiovascular implantable electronic device (CIED) infection and therefore need device extraction. The goal of this study was to identify clinical predictors of CIED infection in patients presenting with SAB. Methods: We retrospectively reviewed all cases of SAB in CIED recipients at Mayo Clinic from Jan 2001 to Dec 2011. CIED infection was defined using clinical, microbiologic and echocardiographic criteria. Patients who presented with clinical signs of CIED pocket infection were excluded. A multivariable model was developed to identify independent predictors of CIED infection. Model discrimination was summarized using the area under a receiver operating characteristics curve (AUC). Results: Among the 131 patients with SAB and CIED, 45 (34%) had underlying CIED infection. Permanent pacemaker (PPM) devices (OR 3.90, 95% CI 1.65-9.23, p=0.002), >1 device-related procedure (OR 3.30, 95% CI 1.23-8.86, p=0.018), and duration of SAB ≥4 days (OR 5.54, 95% CI 3.32-13.23, p <0.001) were independently associated with an increased risk of CIED infection. The AUC for this multivariable model was 0.79 indicating good discriminatory capacity to separate SAB patients with and without CIED infection. Various combinations of these three features and the corresponding predicted probabilities of CIED infection are summarized in Table. Conclusions: An individual patient’s risk of underlying CIED infection can be calculated based on the type of device, number of device-related procedures, and duration of SAB. Patients without any of these high-risk features have very low risk of underlying CIED infection and may be monitored closely without immediate device extraction.

scholarly journals 57. Evaluation of the 2019 European Heart Rhythm Association International Consensus Document in Patients with Cardiovascular Implantable Electronic Devices Who Develop Staphylococcus aureus Bacteremia

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S40-S40
Author(s):  
Supavit Chesdachai ◽  
Larry M Baddour ◽  
Muhammad R Sohail ◽  
Raj Palraj ◽  
Malini Madhavan ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Electronic Device ◽  
Heart Rhythm ◽  
Consensus Document ◽  
Staphylococcus Aureus Bacteremia ◽  
Device Infection ◽  
Significant Difference ◽  
Device Extraction ◽  
One Year ◽  
The Impact

Abstract Background Cardiovascular implantable electronic device (CIED) implantation has markedly increased over the past two decades. Staphylococcus aureus bacteremia (SAB) occurs in patients with CIED and determination of device infection among patients without clinical findings of pocket site infection is often difficult. Our study examines the characteristics, management, and outcomes of SAB in patients living with CIED using 2019 international criteria to define CIED infection. Methods We conducted a retrospective study of patients with CIED who were hospitalized at Mayo Clinic, Rochester, with SAB from January 1, 2012 to December 31, 2019. Patients who met CIED infection criteria following SAB based on the 2019 European Heart Rhythm Association International Concensus Document were identified. A time-to-event analysis was used to determine the impact, if any, of complete device extraction on outcomes. Results Overall, 110 patients with CIED developed SAB and 92 (83.6%) of them underwent transesophageal echocardiogram (TEE). Eighty-eight (80%) had CIED infection with 57 (51.8%) and 31 (28.2%) patients meeeting criteria for definite and possible CIED infections, respectively. Forty-three (75.4%) patients with definite CIED infection underwent complete device extraction. For possible and rejected CIED infection, the rates of complete device extraction were 35.5% and 27.3%, respectively (p&lt; .001 for each). The primary endpoint of a composite of one-year mortality and SAB relapse had a rate that was significantly lower in patients with CIED infection who underwent complete device extraction as compared to that of patients who did not undergo device extraction (25.9% vs. 76.5%, p&lt; .001). No significant difference in outcomes was seen in the rejected CIED infection group (33.3% vs. 62.5%, p =.27). Conclusion The rate of CIED infections following SAB was higher than that reported previously. Increased use of TEE and a novel case definition with broader diagnostic criteria were likely operative, in part, in accounting for the the higher rate of CIED infections complicating SAB. Complete device removal is critical in patients with either definite or possible CIED infection as defined by the 2019 consensus document to improve one-year mortality and SAB relapse rates. Disclosures Larry M. Baddour, MD, Boston Scientific (Individual(s) Involved: Self): Consultant; Botanix Pharmaceuticals (Individual(s) Involved: Self): Consultant; Roivant Sciences (Individual(s) Involved: Self): Consultant Muhammad R. Sohail, MD, Medtronic (Consultant)Philips (Consultant)

Abstract 15979: Utility of Post-extraction Follow-up Blood Cultures in Patients With Cardiovascular Implantable Electronic Device Infection

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
sarwat khalil ◽  
Zerelda Esquer Garrigos ◽  
Douglas W Challener ◽  
Pooja Gurram ◽  
Wajeeha Tariq ◽  
...  
Keyword(s):  
Electronic Device ◽  
Heart Association ◽  
Control Device ◽  
Blood Cultures ◽  
Source Control ◽  
Causative Organism ◽  
Study Cohort ◽  
Device Removal ◽  
Device Infection ◽  
Device Extraction

Introduction: Cardiovascular implantable electronic devices (CIED) infections are frequently complicated with bloodstream infection (BSI). Complete device removal and prolonged antimicrobial therapy is essential for cure. The frequency of persistent BSI after source control (device extraction) is not well described. This study aims to assess the utility of repeat blood cultures (BC) after device extraction as recommended by the American Heart Association (AHA) guidelines. Methods: We selected patients who presented with BSI in the setting of CIED infection and underwent device removal at Mayo Clinic Rochester between 2012 and 2017. Cases where BC were not drawn prior to extraction, or repeated within 72 hours of device extraction, or met criteria for contamination were excluded. Results: Of 656 patients who underwent CIED extraction for device infection, 190 with post-extraction BC met study criteria. Among the final study cohort (Table 1), 159 patients had negative BC, while 31 had positive BC following CIED extraction. Pre-extraction, the most common causative organism was Staphylococcus aureus (91/190, 48%) (Figure 1a). Post-extraction, 22 of the 31 (71%) cases of persistent BSI were due to S. aureus (Fig 1b). The median duration of BSI was not significantly different between negative and positive BC groups (3 versus 4 days, p=0.92). Conclusions: Majority of patients had resolution of BSI after CIED extraction. S. aureus was the most common cause of persistent BSI post-extraction. Our findings support the AHA guidelines of repeating BC after device extraction, especially for S aureus .

scholarly journals Canine rheumatoid arthritis characterized by hyperprolactinemia

2017 ◽  
Vol 7 (1) ◽  
Author(s):  
Tohru Kimura
Keyword(s):  
Rheumatoid Arthritis ◽  
Antinuclear Antibodies ◽  
Clinical Signs ◽  
Serum Prolactin ◽  
Clinical Predictors ◽  
Increased Risk ◽  
Nodular Lesions ◽  
Dna Antibodies ◽  
Serum Biochemical ◽  
Ulcerative Lesions

The senile female dog suffering from rheumatoid arthritis was clinically and clinicopathologically examined. The articular lesions localized in the elbows, stifles, and the carpal and tarsal joints. The dog with clinical signs of arthritis developed draining nodular lesions in the involved joints. The affected joints became swollen, and then serous exudates were observed in their ulcerative lesions. In addition, the dog developed leaks of milk (lactorrhea) in response to suckling stimuli. There were no abnormal values in hematological and blood coagulation profiles. Serum biochemical examinations showed an increase in total protein concentrations. Serum protein electrophoresis confirmed a prominent decrease in albumin and moderate increases in β1, β2 and γ-globurin. The serum prolactin concentration was apparently higher than that of normal dogs. This affected dog had raised rheumatoid factors and immune complexes. Both antinuclear antibodies and direct Coombs test were positive and serum complement titers and anti DNA antibodies were increased in this dog. In conclusion, the present results revealed that lactorrhea characterized by hyperprolactinemia and autoimmunological profiles was one of important clinical predictors associated with an increased risk of rheumatoid arthritis.

scholarly journals 732Predictors of Cardiac Implantable Electronic Device Infection in Patients with Staphylococcus Aureus Bacteremia

2014 ◽  
Vol 1 (suppl_1) ◽  
pp. S206-S207
Author(s):  
Hassan Elmalik ◽  
Madhu Reddy ◽  
Michael Brimacombe ◽  
Kassem Hammoud ◽  
Raghuveer Dendi ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Electronic Device ◽  
Cardiac Implantable Electronic Device ◽  
Staphylococcus Aureus Bacteremia ◽  
Device Infection

Abstract 15408: Risk Factors Associated With In-hospital Mortality for Cardiac Device Extraction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
James B Hammock ◽  
Chad Colon ◽  
James Barrios ◽  
Blake Smith ◽  
Vedran Oruc ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospital Mortality ◽  
Laboratory Data ◽  
Severe Malnutrition ◽  
Hospital Death ◽  
Cardiac Device ◽  
Extraction Procedures ◽  
Increased Risk ◽  
Device Infection ◽  
Device Extraction

Introduction: Cardiac device extraction procedures are associated with increased risk of in-hospital mortality. The objective of this study was to determine risk factors for in-hospital mortality of patients undergoing cardiac device extraction. Methods: We studied patients undergoing cardiac device removal between January 2016 and December 2019 at a single tertiary care center. Baseline patient characteristics, comorbidities, and preoperative laboratory data were obtained by database query (Table 1) . The outcome of interest was in-hospital death following cardiac device extraction. Odds ratios (OR) and confidence intervals (CI) were used to measure relationships between exposures and the main outcome. Results: Our cohort consisted of 333 patients who underwent cardiac device extraction procedures. Cardiac device infection was the indication for procedure in 48% of patients (n=161). In-hospital mortality occurred in 9% of patients (n=29). Patients that died inpatient post-operatively were more likely to be male gender (OR 3.59, 95% CI [1.2, 10.6], p = 0.02), have acute kidney failure (OR 3.17, 95% CI [1.42, 7.05], p = 0.005), have anemia (OR 3.22, 95% CI [1.49, 6.99], p = 0.003), or have a diagnosis of severe malnutrition (OR 2.88, 95% CI [1.26, 6.58], p = 0.01). In a subgroup analysis, patients with diabetes undergoing extraction for infectious reasons had an increased risk of in-hospital mortality (OR 4.36, 95% CI [1.54, 12.34], p = 0.005). Conclusion: Patients undergoing cardiac device extraction are high risk for in-hospital mortality. Patients experiencing in-hospital mortality were more likely to be male, have acute renal failure, anemia and severe malnutrition. Careful analysis of preoperative risk factors, laboratory data, and nutritional status can help stratify risk for patients and providers.

scholarly journals O06 Baseline predictors of methotrexate-related adverse events in methotrexate-naïve patients with RA

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Ahmad A Sherbini ◽  
James M Gwinnutt ◽  
Kimme L Hyrich ◽  
Suzanne M M Verstappen ◽  
Keyword(s):  
Rheumatoid Arthritis ◽  
Adverse Events ◽  
Health Assessment ◽  
Prevalence Rates ◽  
Clinical Predictors ◽  
Research Support ◽  
Related Data ◽  
Increased Risk ◽  
One Year

Abstract Background/Aims  Methotrexate (MTX) is the most common treatment for rheumatoid arthritis (RA). The prevalence of adverse events (AEs) associated with MTX treatment for RA have been studied extensively, but there are limited data on the predictors of these AEs. This study aims to summarise the prevalence rates of MTX AEs, including gastrointestinal (GI), neurological, mucocutaneous, and elevated alanine transaminase (ALT) enzyme, and to identify baseline demographic and clinical predictors of these AEs. Methods  The Rheumatoid Arthritis Medication Study (RAMS) is a UK multi-centre prospective cohort study of patients with RA starting MTX for the first time. Relevant demographic, medication, clinical and disease related data were collected at baseline. AEs were reported at six and twelve months follow-ups. The prevalence rates of AEs were calculated based on the proportions of patients who reported having had an AE within one year of follow-up. The associations between candidate baseline predictors and AEs were assessed using multivariable logistic regression. Results  A total of 2,089 patients were included with a mean age of 58.4 (standard deviation: 13.5) years, 1390 (66.5%) were women. 1,814 and 1,579 patients completed the 6 and 12 months follow-up visits, respectively. The prevalence rates of the AEs within one year of follow-up were: GI = 777 (40.6%), mucocutaneous = 441 (23.1%), neurological = 487 (25.5%), elevated ALT (&gt; upper limit of normal [ULN]) = 286 (15.5%). Younger age and being a woman were associated with increased risk of GI AEs, (age: OR 0.97 per year increase in age, 95% CI 0.98, 1.00; male sex: OR 0.58 vs female, 95% CI 0.46, 0.74) (Table 1). Higher baseline Health Assessment Questionnaire (HAQ) score was an independent predictor of GI, mucocutaneous, and neurological AEs. Furthermore, having ALT &gt;1xULN at baseline or history of diabetes was associated with increased risk of subsequent ALT elevation during the study follow-up. Conclusion  In patients with RA starting MTX, GI AEs were the most commonly reported AEs during the first year of follow-up. The identified predictors of AEs may facilitate discussions between clinicians and patients prior to commencing MTX, and may lead to increased adherence and consequently improved effectiveness. Disclosure  A.A. Sherbini: None. J.M. Gwinnutt: Grants/research support; BMS. K.L. Hyrich: Member of speakers’ bureau; Abbvie. Grants/research support; Pfizer, UCB, BMS. S.M.M. Verstappen: Consultancies; Celltrion. Member of speakers’ bureau; Pfizer. Grants/research support; BMS.

scholarly journals Postimplantation pocket hematoma increases risk of cardiac implantable electronic device infection: A meta‐analysis

2021 ◽  
Author(s):  
Jakrin Kewcharoen ◽  
Chanavuth Kanitsoraphan ◽  
Sittinun Thangjui ◽  
Thiratest Leesutipornchai ◽  
Sakditad Saowapa ◽  
...  
Keyword(s):  
Electronic Device ◽  
Meta Analysis ◽  
Cardiac Implantable Electronic Device ◽  
Device Infection ◽  
Pocket Hematoma

scholarly journals MiR-126-3p and MiR-223-3p as Biomarkers for Prediction of Thrombotic Risk in Patients with Acute Myocardial Infarction and Primary Angioplasty

2021 ◽  
Vol 11 (6) ◽  
pp. 508
Author(s):  
Milan Hromadka ◽  
Zuzana Motovska ◽  
Ota Hlinomaz ◽  
Petr Kala ◽  
Frantisek Tousek ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Predictive Accuracy ◽  
Cardiovascular Death ◽  
Primary Angioplasty ◽  
Bleeding Complications ◽  
Clinical Predictors ◽  
Thrombotic Risk ◽  
Increased Risk ◽  
One Year

Aim. This study was designed to evaluate the relationship between microRNAs (miRNAs), miR-126-3p and miR-223-3p, as new biomarkers of platelet activation, and predicting recurrent thrombotic events after acute myocardial infarction (AMI). Methods and Results. The analysis included 598 patients randomized in the PRAGUE-18 study (ticagrelor vs. prasugrel in AMI). The measurements of miRNAs were performed by using a novel miRNA immunoassay method. The association of miRNAs with the occurrence of the ischemic endpoint (EP) (cardiovascular death, nonfatal MI, or stroke) and bleeding were analyzed. The miR-223-3p level was significantly related to an increased risk of occurrence of the ischemic EP within 30 days (odds ratio (OR) = 15.74, 95% confidence interval (CI): 2.07–119.93, p = 0.008) and one year (OR = 3.18, 95% CI: 1.40–7.19, p = 0.006), respectively. The miR-126-3p to miR-223-3p ratio was related to a decreased risk of occurrence of EP within 30 days (OR = 0.14, 95% CI: 0.03–0.61, p = 0.009) and one year (OR = 0.37, 95% CI: 0.17–0.82, p = 0.014), respectively. MiRNAs were identified as independent predictors of EP even after adjustment for confounding clinical predictors. Adding miR-223-3p and miR-126-3p to miR-223-3p ratios as predictors into the model calculating the ischemic risk significantly increased the predictive accuracy for combined ischemic EP within one year more than using only clinical ischemic risk parameters. No associations between miRNAs and bleeding complications were identified. Conclusion. The miR-223-3p and the miR-126-3p are promising independent predictors of thrombotic events and can be used for ischemic risk stratification after AMI.

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