Cardiac Implantable Electronic Device-Related Infective Endocarditis Outcomes

Cardiac implantable electronic device-related (CIED) infective endocarditis (IE) is diagnosed in a third of patients with CIED infections, often presents with sepsis, and is frequently late-onset; older age and sepsis are associated with greater mortality risk in patients with CIED-IE. This research was presented at IDWeek 2019, held October 2 to 6, 2019, in Washington, DC.

The investigators of this study used data from the prospective Multicenter Electrophysiologic Device Infection Cohort to characterize patients with definite CIED-IE who fulfilled both major modified Duke criteria (bloodstream infection with intracardiac vegetations). 

Of 433 patients included in the study, 144 (33.3%) had definite CIED-IE: 77 patients (53.5%) had permanent pacemakers, 38 (26.4%) had implantable cardioverter defibrillators, and 29 (20.1%) had combination devices. The median age of patients with CIED-IE was 68 years, and most were men (77.1%).

A history of CIED infection was reported by 12 patients (8.3%). The median time from the last device procedure was 550 days; however, early-onset CIED-IE was observed in 60 patients (41.7%), and late-onset CIED-IE was observed in 84 patients (58.3%). The most common symptoms were fever (77.8%) and sepsis (44.4%); symptoms lasted a median duration of 7 days.

On echocardiography, 125 patients (86.8%) had intracardiac lead vegetations, and 54 patients (37.5%) had intracardiac valvular vegetations in which the tricuspid valve was involved in over half the cases (56.5%).

Based on the location of the vegetations, 90 patients (62.5%) had isolated lead-related infective endocarditis, 19 patients (13.2%) had isolated valve-related infective endocarditis, and 35 patients (24.3%) had both. In bloodstream analyses, all patients had positive blood cultures and 52.9% had positive lead cultures. The most common organism in the blood was Staphylococcus aureus (42.4%) and coagulase-negative staphylococci (20.1%).

CIED removal was common, occurring in 131 patients (91.0%). During index hospitalization, 25 deaths were reported, and 34 total deaths were reported at 6 months.

In analyses, the researchers concluded that mortality risk was associated with sepsis (P =.052) and age >75 years (P =.023); the infecting organism, location of intracardiac vegetations, and device removal did not affect risk for death.  

Disclosure: One author reported affiliations with the pharmaceutical industry. Please see the reference for complete disclosure information.

Reference

Gupta S, Wierzba TF, Peacock Jr JE, et al. Cardiac implantable electronic device-related infective endocarditis (CIED-IE): clinical features and outcomes of patients with definite IE who fulfill both major Duke criteria. Presented at: IDWeek 2019; October 3, 2019; Washington, DC. Abstract 121.

This article originally appeared on Infectious Disease Advisor