{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T11:24:10Z","timestamp":1780053850928,"version":"3.54.0"},"reference-count":49,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,2,22]],"date-time":"2025-02-22T00:00:00Z","timestamp":1740182400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Cardiac implantable electronic device (CIED) infections caused by Gram-negative bacteria are uncommon but potentially life-threatening. This study examined patients with Gram-negative CIED infections, investigating the clinical characteristics of patients harboring multidrug-resistant (MDR), versus non-MDR, isolates. A retrospective observational analysis was conducted at two tertiary Greek University Hospitals from 2015 to 2020. Patients were identified through microbiological cultures from device-related sites (pocket, lead, generator), with infections classified as MDR or non-MDR based on antimicrobial susceptibility profiles. Comprehensive data were collected, including demographic characteristics, clinical parameters, procedural details\u2014on both the last device procedure and subsequent extraction procedure\u2014infection-related findings, and microbiological profiles. In total, 18 patients were identified, with an equal distribution of 9 MDR and 9 non-MDR cases. The study population had a median age of 78 years, with 33.3% female patients, and a median Charlson Comorbidity Index of four. Pseudomonas aeruginosa was the most prevalent isolated species. Comparative analysis revealed that MDR patients had higher median SOFA (Sequential Organ Failure Assessment) scores (2 vs. 0, p = 0.07), longer time to device extraction (50% vs. 88.9% extracted within one month, p = 0.079), and higher blood culture positivity (80% vs. 37.5%, p = 0.135). Despite similar demographic characteristics, MDR infections demonstrated more complex clinical profiles, with a trend towards increased disease severity.<\/jats:p>","DOI":"10.3390\/pathogens14030215","type":"journal-article","created":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T06:47:17Z","timestamp":1740379637000},"page":"215","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Gram-Negative Bacterial Infections in Cardiac Implantable Electronic Devices: Insights from a Retrospective Analysis of Multidrug-Resistant and Non-Multidrug-Resistant Isolates"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7963-1865","authenticated-orcid":false,"given":"Georgios","family":"Schinas","sequence":"first","affiliation":[{"name":"School of Medicine, University of Patras, 26504 Rio, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6890-5127","authenticated-orcid":false,"given":"Rafail","family":"Koros","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University General Hospital of Patras, 26504 Rio, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioannis","family":"Ntalakouras","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ippokrateio General Hospital of Athens, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Skevos","family":"Sideris","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ippokrateio General Hospital of Athens, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2290-3940","authenticated-orcid":false,"given":"Angelos","family":"Perperis","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University General Hospital of Patras, 26504 Rio, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3982-5101","authenticated-orcid":false,"given":"Georgios","family":"Leventopoulos","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Patras, 26504 Rio, Greece"},{"name":"Division of Cardiology, University General Hospital of Patras, 26504 Rio, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Periklis","family":"Davlouros","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Patras, 26504 Rio, Greece"},{"name":"Division of Cardiology, University General Hospital of Patras, 26504 Rio, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4289-9494","authenticated-orcid":false,"given":"Karolina","family":"Akinosoglou","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Patras, 26504 Rio, Greece"},{"name":"Department of Internal Medicine and Division of Infectious Diseases, University General Hospital of Patras, 26504 Rio, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1097\/HCO.0b013e328341384e","article-title":"Cardiovascular implantable electrophysiological device-related infections: A review","volume":"26","author":"Gould","year":"2011","journal-title":"Curr. Opin. Cardiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1016\/j.mcna.2019.04.005","article-title":"Cardiac Implantable Electronic Device Therapy: Permanent Pacemakers, Implantable Cardioverter Defibrillators, and Cardiac Resynchronization Devices","volume":"103","author":"Steffen","year":"2019","journal-title":"Med. Clin. N. Am."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"ofac547","DOI":"10.1093\/ofid\/ofac547","article-title":"Forty-Year Trends in Cardiac Implantable Electronic Device Infective Endocarditis","volume":"9","author":"Llopis","year":"2022","journal-title":"Open Forum Infect. Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1111\/pace.13009","article-title":"Cardiac Implantable Electronic Device-Related Infection and Extraction Trends in the U.S","volume":"40","author":"Sridhar","year":"2017","journal-title":"Pacing Clin. Electrophysiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1490","DOI":"10.1093\/europace\/euu147","article-title":"Risk factors for 1-year mortality among patients with cardiac implantable electronic device infection undergoing transvenous lead extraction: The impact of the infection type and the presence of vegetation on survival","volume":"16","author":"Tarakji","year":"2014","journal-title":"Europace"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1111\/pace.12518","article-title":"Increased long-term mortality in patients with cardiovascular implantable electronic device infections","volume":"38","author":"Henrikson","year":"2015","journal-title":"Pacing Clin. Electrophysiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1334","DOI":"10.1093\/europace\/eus044","article-title":"Microbiology of cardiac implantable electronic device infections","volume":"14","author":"Bongiorni","year":"2012","journal-title":"Europace"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1016\/j.jacep.2016.01.019","article-title":"Microbiology of Cardiac Implantable Electronic Device Infections","volume":"2","author":"Baghdy","year":"2016","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1016\/j.jacep.2021.03.021","article-title":"A Review of Cardiac Implantable Electronic Device Infections for the Practicing Electrophysiologist","volume":"7","author":"Palmeri","year":"2021","journal-title":"Clin. Electrophysiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1268","DOI":"10.1016\/j.mayocp.2018.11.029","article-title":"Clinical Presentation, Management, and Outcomes of Cardiovascular Implantable Electronic Device Infections Due to Gram-Negative Versus Gram-Positive Bacteria","volume":"94","author":"George","year":"2019","journal-title":"Mayo Clin. Proc."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"ofac444","DOI":"10.1093\/ofid\/ofac444","article-title":"Risk of Cardiovascular Implantable Electronic Device Infection in Patients Presenting with Gram-Negative Bacteremia","volume":"9","author":"Chesdachai","year":"2022","journal-title":"Open Forum Infect. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1086\/506942","article-title":"Frequency of permanent pacemaker or implantable cardioverter-defibrillator infection in patients with gram-negative bacteremia","volume":"43","author":"Uslan","year":"2006","journal-title":"Clin. Infect. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2085","DOI":"10.1161\/CIRCULATIONAHA.110.936708","article-title":"Nonstaphylococcal infections of cardiac implantable electronic devices","volume":"121","author":"Viola","year":"2010","journal-title":"Circulation"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Mishra, A., Aggarwal, A., and Khan, F. (2024). Medical Device-Associated Infections Caused by Biofilm-Forming Microbial Pathogens and Controlling Strategies. Antibiotics, 13.","DOI":"10.3390\/antibiotics13070623"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Bari, A.K., Belalekar, T.S., Poojary, A., and Rohra, S. (2023). Combination drug strategies for biofilm eradication using synthetic and natural agents in KAPE pathogens. Front. Cell. Infect. Microbiol., 13.","DOI":"10.3389\/fcimb.2023.1155699"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e004822","DOI":"10.1161\/CIRCEP.116.004822","article-title":"Reimplantation and Repeat Infection After Cardiac-Implantable Electronic Device Infections: Experience from the MEDIC (Multicenter Electrophysiologic Device Infection Cohort) Database","volume":"10","author":"Boyle","year":"2017","journal-title":"Circ. Arrhythmia Electrophysiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1089\/mdr.2018.0027","article-title":"Relationship Between Biofilm Formation and Antimicrobial Resistance in Gram-Negative Bacteria","volume":"25","author":"Cepas","year":"2019","journal-title":"Microb. Drug Resist."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"106734","DOI":"10.1016\/j.ijantimicag.2023.106734","article-title":"Risk factors for Gram-negative bacterial infection of cardiovascular implantable electronic devices: Multicentre observational study (CarDINe Study)","volume":"61","author":"Pascale","year":"2023","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1016\/j.ajic.2008.03.002","article-title":"CDC\/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting","volume":"36","author":"Horan","year":"2008","journal-title":"Am. J. Infect. Control"},{"key":"ref_20","first-page":"e01028-23","article-title":"Laboratory approaches to determining blood culture contamination rates: An ASM Laboratory Practices Subcommittee report","volume":"62","year":"2023","journal-title":"J. Clin. Microbiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e02208-17","DOI":"10.1128\/AAC.02208-17","article-title":"Risk factors and outcomes of endocarditis due to non-HACEK gram-negative bacilli: Data from the prospective multicenter Italian endocarditis study cohort","volume":"62","author":"Falcone","year":"2018","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e01499","DOI":"10.1016\/j.idcr.2022.e01499","article-title":"Prevotella bivia cardiac implantable electronic device related endocarditis","volume":"28","author":"Fogelson","year":"2022","journal-title":"IDCases"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Tsalidou, M., Stergiopoulou, T., Bostanitis, I., Nikaki, C., Skoumpa, K., Koutsoukou, T., and Papaioannidou, P. (2023). Surveillance of Antimicrobial Resistance and Multidrug Resistance Prevalence of Clinical Isolates in a Regional Hospital in Northern Greece. Antibiotics, 12.","DOI":"10.3390\/antibiotics12111595"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1093\/cid\/cir323","article-title":"The challenges of antimicrobial drug resistance in Greece","volume":"53","author":"Miyakis","year":"2011","journal-title":"Clin. Infect. Dis."},{"key":"ref_25","unstructured":"European Centre for Disease Prevention and Control (2023). Antimicrobial Resistance Surveillance in Europe 2023\u20142021 Data."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1007\/s10096-024-04806-x","article-title":"Multidrug-resistant organism bloodstream infection and hospital acquisition among inpatients in three tertiary Greek hospitals during the COVID-19 era","volume":"43","author":"Karakosta","year":"2024","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Polemis, M., Mandilara, G., Pappa, O., Argyropoulou, A., Perivolioti, E., Koudoumnakis, N., Pournaras, S., Vasilakopoulou, A., Vourli, S., and Katsifa, H. (2021). COVID-19 and Antimicrobial Resistance: Data from the Greek Electronic System for the Surveillance of Antimicrobial Resistance-WHONET-Greece (January 2018\u2013March 2021). Life, 11.","DOI":"10.3390\/life11100996"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"dlab038","DOI":"10.1093\/jacamr\/dlab038","article-title":"The potential impact of the COVID-19 pandemic on global antimicrobial and biocide resistance: An AMR Insights global perspective","volume":"3","author":"Ansari","year":"2021","journal-title":"JAC Antimicrob. Resist."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.ejim.2020.02.030","article-title":"Predictors of infection after \u201cde novo\u201d cardiac electronic device implantation","volume":"77","author":"Balla","year":"2020","journal-title":"Eur. J. Intern. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1016\/j.ijcard.2017.07.061","article-title":"The \u201cSubtle\u201d connection between development of cardiac implantable electrical device infection and survival after complete system removal: An observational prospective multicenter study","volume":"250","author":"Diemberger","year":"2018","journal-title":"Int. J. Cardiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1111\/jce.12684","article-title":"Health and Economic Outcomes Associated with Use of an Antimicrobial Envelope as a Standard of Care for Cardiac Implantable Electronic Device Implantation","volume":"26","author":"Shariff","year":"2015","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1930","DOI":"10.1007\/s00134-012-2695-9","article-title":"Characteristics and determinants of outcome of hospital-acquired bloodstream infections in intensive care units: The EUROBACT International Cohort Study","volume":"38","author":"Tabah","year":"2012","journal-title":"Intensive Care Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1093\/cid\/ciy955","article-title":"The Mortality Burden of Multidrug-resistant Pathogens in India: A Retrospective, Observational Study","volume":"69","author":"Gandra","year":"2019","journal-title":"Clin. Infect. Dis."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Schinas, G., Skintzi, K., De Lastic, A.L., Rodi, M., Gogos, C., Mouzaki, A., and Akinosoglou, K. (2023). Patterns, Cost, and Immunological Response of MDR vs. Non MDR-Bacteremia: A Prospective Cohort Study. Pathogens, 12.","DOI":"10.3390\/pathogens12081044"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.amjms.2018.11.009","article-title":"Impact of Delayed Appropriate Antibiotic Therapy on Patient Outcomes by Antibiotic Resistance Status from Serious Gram-negative Bacterial Infections","volume":"357","author":"Bonine","year":"2019","journal-title":"Am. J. Med. Sci."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1016\/j.chest.2020.03.087","article-title":"A Systematic Review of the Effect of Delayed Appropriate Antibiotic Treatment on the Outcomes of Patients with Severe Bacterial Infections","volume":"158","author":"Zasowski","year":"2020","journal-title":"Chest"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1088","DOI":"10.1016\/j.chest.2019.02.324","article-title":"Clinical Impact of Antimicrobial Resistance: Using New Tools to Answer Old Questions","volume":"155","author":"Niederman","year":"2019","journal-title":"Chest"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"E1","DOI":"10.1093\/ejcts\/ezz296","article-title":"European Heart Rhythm Association (EHRA) international consensus document on how to prevent, diagnose, and treat cardiac implantable electronic device infections\u2014Endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), the Latin American Heart Rhythm Society (LAHRS), International Society for Cardiovascular Infectious Diseases (ISCVID) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)","volume":"57","author":"Traykov","year":"2020","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1617","DOI":"10.1007\/s00259-014-2773-z","article-title":"Role of (1)(8)F-FDG PET\/CT in the diagnosis of infective endocarditis in patients with an implanted cardiac device: A prospective study","volume":"41","author":"Graziosi","year":"2014","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1007\/s12350-020-02285-z","article-title":"Accuracy of (18)F-FDG PET\/CT in patients with the suspicion of cardiac implantable electronic device infections","volume":"29","author":"Jeronimo","year":"2022","journal-title":"J. Nucl. Cardiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1862","DOI":"10.1093\/eurheartj\/ehz316","article-title":"Incidence of device-related infection in 97 750 patients: Clinical data from the complete Danish device-cohort (1982\u20132018)","volume":"40","author":"Olsen","year":"2019","journal-title":"Eur. Heart J."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1821","DOI":"10.1001\/archinternmed.2011.441","article-title":"Mortality and cost associated with cardiovascular implantable electronic device infections","volume":"171","author":"Sohail","year":"2011","journal-title":"Arch. Intern. Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1111\/j.1540-8159.2010.02931.x","article-title":"Implantation success and infection in cardiovascular implantable electronic device procedures utilizing an antibacterial envelope","volume":"34","author":"Bloom","year":"2011","journal-title":"Pacing Clin. Electrophysiol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1111\/pace.12063","article-title":"Use of an antibacterial envelope is associated with reduced cardiac implantable electronic device infections in high-risk patients","volume":"36","author":"Kolek","year":"2013","journal-title":"Pacing Clin. Electrophysiol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1002\/joa3.12262","article-title":"Role of antibiotic envelopes in preventing cardiac implantable electronic device infection: A meta-analysis of 14 859 procedures","volume":"36","author":"Kumar","year":"2020","journal-title":"J. Arrhythmia"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Traykov, V., and Blomstr\u00f6m-Lundqvist, C. (2022). Antibiotic-Eluting Envelopes for the Prevention of Cardiac Implantable Electronic Device Infections: Rationale, Efficacy, and Cost-Effectiveness. Front. Cardiovasc. Med., 9.","DOI":"10.3389\/fcvm.2022.855233"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1055\/s-0036-1580733","article-title":"Treatment of Infected Cardiac Implantable Electronic Devices","volume":"30","author":"Fakhro","year":"2016","journal-title":"Semin. Plast. Surg."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"e201","DOI":"10.1161\/CIR.0000000000001187","article-title":"Update on Cardiovascular Implantable Electronic Device Infections and Their Prevention, Diagnosis, and Management: A Scientific Statement From the American Heart Association: Endorsed by the International Society for Cardiovascular Infectious Diseases","volume":"149","author":"Baddour","year":"2024","journal-title":"Circulation"},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Torres, I., Huntley, D., Tormo, M., Calabuig, M., Hern\u00e1ndez-Boluda, J.C., Terol, M.J., Carretero, C., de Michelena, P., P\u00e9rez, A., and Pi\u00f1ana, J.L. (2022). Multi-body-site colonization screening cultures for predicting multi-drug resistant Gram-negative and Gram-positive bacteremia in hematological patients. BMC Infect. Dis., 22.","DOI":"10.1186\/s12879-022-07154-3"}],"container-title":["Pathogens"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-0817\/14\/3\/215\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:40:17Z","timestamp":1760028017000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-0817\/14\/3\/215"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,22]]},"references-count":49,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,3]]}},"alternative-id":["pathogens14030215"],"URL":"https:\/\/doi.org\/10.3390\/pathogens14030215","relation":{},"ISSN":["2076-0817"],"issn-type":[{"value":"2076-0817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,22]]}}}