Clinical Characteristics and Outcome of Infective Endocarditis Involving Implantable Cardiac Devices | Cardiology | JAMA | JAMA Network
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Original Contribution
April 25, 2012

Clinical Characteristics and Outcome of Infective Endocarditis Involving Implantable Cardiac Devices

Author Affiliations

Author Affiliations: Department of Infectious Diseases, Barwon Health, Geelong, Australia (Drs Athan and Henry); Duke Clinical Research Institute (Drs Chu and Fowler and Mr Pappas) and Department of Medicine (Drs Crowley and Wang), Duke University Medical Center, Durham, North Carolina; Infectious Diseases and ICU, Pontchaillou University, Rennes, France (Dr Tattevin); CHU Nancy-Brabois, Nancy, France (Dr Selton-Suty); University of New South Wales, Sydney, Australia (Dr Jones); Department of Cardiology, West German Heart Center, Essen (Dr Naber); Hospital Clinic–IDIBAPS, University of Barcelona, Barcelona, Spain (Drs Miró and Ninot); Hospital Universitari Vall d’Hebron, Barcelona (Dr Fernández-Hidalgo); Second University of Naples, Monaldi Hospital, Naples, Italy (Dr Durante-Mangoni); Alfred Hospital, Melbourne, Australia (Dr Spelman); University Medical Centre of Besancon, Besancon, France (Dr Hoen); Medical Center Ljubljana, Ljubljana, Slovenia (Dr Lejko-Zupanc); Maria Vittoria Hospital, Torino, Italy (Dr Cecchi); Faculté de Medicine de Marseille, Marseille, France (Dr Thuny); and Department of Microbiology, Mater University Hospitals, Dublin, Ireland (Dr Hannan).

JAMA. 2012;307(16):1727-1735. doi:10.1001/jama.2012.497

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.