Work

Welcoming Discourse on the Approach for Gram-Negative Bacteremia and Candidemia in Cardiovascular Implantable Electronic Device Infections

Year: 2024

Type: article

Abstract: To theEditor—We want to thank Drs Chesdachai, Baddour, and DeSimone for their thoughtful and informative comments addressing clinical indications ratings for gram-negative bacteremia with atypical organisms and candidemia in cardiovascular implantable electronic device infections (CIEDI). We also appreciate their support of our multisocietal consensus statement [1] and efforts to provide fair, optimal ratings. We believe that the authors highlight some important considerations and further clarify clinical indications in this challenging disease state. The authors highlight a low rate of CIEDI in gram-negative bacteremia with atypical organisms, and we agree that imaging should be used less frequently in this scenario. However, as the authors highlight, there are specific situations in which imaging may be appropriate, such as in infection with Pseudomonas or Serratia species or with persistent/recurrent bacteremia without an identified source. Ratings are set to “May Be Appropriate” by design when these variations are present. Moreover, this rating is used to highlight a need for further research. Patients with equivocal or non-diagnostic imaging were felt by the raters to represent a higher-risk subgroup, and thus imaging was deserving of an “Appropriate” rating. Moreover, the text included a recommendation that imaging “should only be considered in select cases with higher clinical suspicion,” We thank the authors for generating an important discussion of this challenging patient subgroup. We agree with the authors regarding the unique relationship between candidemia and risk of CIEDI, which could justify considering these patients within a separate category in the table. Although this scenario may warrant urgent intervention without further testing due to high morbidity and mortality, timing was not explicitly considered in the ratings. Moreover, patients were assumed to be well enough to undergo the test. As with the scenarios above, patients with candidemia and known or suspected CIEDI are an important population for further research. The authors bring up important issues, and we acknowledge and appreciate their contributions to this disease state. Ongoing discourse and targeted research will ultimately help refine our clinical indications and optimize use of these imaging techniques in the assessment of cardiovascular infection.

Source: Clinical Infectious Diseases

DOI: 10.1093/cid/ciae323

Authors: Jamieson M Bourque, Vivian H Chu, Pamela K Mason, Robert D Schaller, Ann E Woolley, Sharmila Dorbala