Clinical Characteristics and Outcome of Infective EndocarditisInvolving Implantable Cardiac Devices
2012
Context Infection of implantable cardiac devices is an emerging
disease with significant morbidity, mortality, and health care
costs. Objectives To describe the clinical characteristics and
outcome of cardiac device infective endocarditis (CDIE) with
attention to its health care association and to evaluate the
association between device removal during index hospitalization
and outcome. Design, Setting, and Patients Prospective cohort
study using data from the International Collaboration on
Endocarditis-Prospective Cohort Study (ICE-PCS), conducted June
2000 through August 2006 in 61 centers in 28 countries.
Patients were hospitalized adults with definite endocarditis as
defined by modified Duke endocarditis criteria. Main Outcome
Measures In-hospital and 1-year mortality. Results CDIE was
diagnosed in 177 (6.4% [95% CI, 5.5%-7.4%]) of a total cohort
of 2760 patients with definite infective endocarditis. The
clinical profile of CDIE included advanced patient age (median,
71.2 years [interquartile range, 59.8-77.6]); causation by
staphylococci (62 [35.0% {95% CI, 28.0%-42.5%}] Staphylococcus
aureus and 56 [31.6% {95% CI, 24.9%-39.0%}] coagulase-negative
staphylococci); and a high prevalence of health care-associated
infection (81 [45.8% {95% CI, 38.3%-53.4%}]). There was
coexisting valve involvement in 66 (37.3% [95% CI,
30.2%-44.9%]) patients, predominantly tricuspid valve infection
(43/177 [24.3%]), with associated higher mortality. In-hospital
and 1-year mortality rates were 14.7% (26/177 [95% CI,
9.8%-20.8%]) and 23.2% (41/177 [95% CI, 17.2%-30.1%]),
respectively. Proportional hazards regression analysis showed a
survival benefit at 1 year for device removal during the
initial hospitalization (28/141 patients [19.9%] who underwent
device removal during the index hospitalization had died at 1
year, vs 13/34 [38.2%] who did not undergo device removal;
hazard ratio, 0.42 [95% CI, 0.22-0.82]). Conclusions Among
patients with CDIE, the rate of concomitant valve infection is
high, as is mortality, particularly if there is valve
involvement. Early device removal is associated with improved
survival at 1 year. JAMA. 2012;307(16):1727-1735
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