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Funding Acknowledgements Type of funding sources: None. Background Infective endocarditis (IE) is a rare, but life-threatening complication of cardiac device implantation. Despite recent preventive strategies and advances in antimicrobial and surgical treatment, morbidity and mortality rates are still high. Aims The objective of our study was to assess the epidemiological characteristics, temporal trends and mortality rates of cardiac device related IE (CDRIE) in our high-volume, tertiary referral center. Methods retrospective data collection was performed between January 1, 2006 and March 31, 2022. Median follow-up was 3.8 yrs (IQR: 0.6 – 9.2 yrs). Patients admitted between 2006 and 2013 (group 1) and between 2014 and 2022 (group 2) were compared to assess temporal trends. Thirty-day, 6-month and 1-year mortality rates were estimated. Results During the observed 17 years 82 patients were admitted with CDRIE (61 males [74%]), mean age: 57.3 ±18 yrs; 6 VVI, 7 VDD, 17 VVI-ICD, 24 DDD, 10 DDD-ICD and 18 CRT devices [4 CRT-P, 14 CRT-D]); median time since first implantation was 3.8 yrs [IQR: 1.1 – 6.6 yrs]). Staphylococci were the most prevalent infective agents (62%), S. aureus (SA) infection was found in 37 cases (out of whom 13 were MRSA [16%]), coagulase negative Staphylococcus in 14 cases (17%), Enterococcus faecalis in 9 cases (11%), streptococci in 4 cases (5%), blood culture was negative in 13 cases (15%), and in 5 cases other pathogens were the underlying microorganism. Patients in Group 1 (n=42) did not differ from patients in Group 2 (n=40) in terms of age, male gender or ejection fraction. Patients in Group 2 had higher CRP level at admission (42,9 [IQR:34-55] mmol/l vs 90 [IQR:25-60] mmol/l, p=0.02). ICD lead (29% vs 67%, p<0.001) and E. faecalis infection (2% vs 20%, p=0.03) and percutan extraction (55% vs 75%, p=0.05) were more prevalent in Group 2. The 30-day and 6-month mortality rates were worse in Group 2 than in Group 1 (2% vs 17.5% p=0.03; and 16% vs 35% p=0.04 resp.) while the 1-year mortality did not differ (24% vs 40%). The all-cause mortality was 10% at 30 days, 26% at 6 month and 32% at 1 year. Univariate regression showed that age (HR: 1.03 [1.01-1.07] p<0.05), ejection fraction (HR: 0.96 [0.93-0.98] p<0.005), ICD lead (HR: 4.89 [1.82-14.40] p<0.005) and the time since first implantation (HR: 0.88 [0.77-0.98] p<0.05) were the predictors of 1-year mortality. However, in Cox multiple regression model only age (HR: 1.05 [1.004-1.1] p<0.05) and ICD lead (HR: 1.16 [1.16-17.38] p<0.05) remains independent predictors of outcome at 1 year. Conclusions In the past 17 years the most prevalent underlying microorganism were staphylococcal species, although Enterococcus faecalis infection increased over time. Patients with CDRIE had poor prognosis, every third patient died at 1 year after diagnosis. The short-term prognosis is even worse in the past few years than before, which may be a negative consequence of limited accessibility of healthcare due to COVID 19 pandemic.

Background Despite recent preventive strategies and advances in antimicrobial and surgical treatment the incidence and mortality rate of infective endocarditis (IE) remains high in adult Congenital Heart Disease (ACHD) patients. Purpose The aim of our retrospective study was to assess the clinical and microbiological characteristics, inhospital and one year mortality rates of ACHD patients admitted with IE in our tertiary referral hospital between 2010 and 2020. Methods Definitive diagnosis of IE were in agreement with modified Duke's criteria. Inhospital baseline data and up to one year follow-up data were collected from the hospital records. ACHD patients were classified based on their lesion severity (ESC guideline classification). Survival data and mortality predictors were analysed by Kaplan-Meier estimator and by uni- and multivariate model. Results 60 cases had been treated with IE. Mean age was 37±11.3 years (18–69), and most of them (76.6%, n=46) were men. ACHD complexity was as following: simple 66.7% (n=40), moderate 20% (n=12) and severe 13.3% (n=8). The most common pre-existing congenital cardiac abnormality was bicuspidal aortic valve seen in 52% (n=31) of cases. Sixty four percent (n=37) of patients had previous heart surgery (n=16, artificial heart valve surgery). Majority of patients had a left sided valve endocarditis (85%, n=51). IE related hospital stay was mean 28±9 days. Infection route was presumed in 30% of patients (n=18), they had an invasive procedure within 6 months preceding the IE diagnosis. Besides common bacterinemia caused by Staphylococcus (33%, n=20) and Streptococcus (25%, n=15), 18% (n=11) of patients had a negative blood culture. IE affected 36 patients with a native valve, and all 16 with an artificial valve. Seventy seven percent of patients required surgical intervention, immediate or urgent surgery in 22 and elective in 24 patients. Overall inhospital mortality was 13%, the majority 5 out of 8 patients having an immediate/emergent surgical intervention. IE was complicated by acute heart failure in 17 (28%) and by stroke in 4 (6.7%) patients. During one year follow-up 21 patients (38%) remained with chronic heart failure, and 3 more died. There was no significant difference in mortality between ACHD complexity groups, and no significant predictors of mortality were found. Conclusion The most common ACHD lesion affected by IE was bicuspid aortic valve. Two-third of patients required surgical intervention, those with immediate/emergent surgery having a 22% early mortality rate. ACHD complexity was not related to early or late outcome in this population. Funding Acknowledgement Type of funding sources: None.

Background Infective endocarditis (IE) is a rare, but life-threatening complication of cardiac device implantation. Despite recent preventive strategies, and advances in antimicrobial and surgical treatment, morbidity and mortality rates are still high. Aims The objective of our study was to assess the epidemiological characteristics, temporal tends and mortality rate of cardiac device related IE (CDRIE) in our high-volume, tertiary referral center. Methods retrospective data collection was performed from January 1, 2006 to December 31, 2016. Thirty-day, 6-month and 1-year mortality was estimated, which were compared to left-sided native valve endocarditis (LSNIE). Patients administered between 2006 and 2010 and between 2011 and 2016 were compared to assess temporal trends. Results 465 cases of IE were administered, out of whom 54 patients had CDRIE (39 males [72%], mean age: 55.8 ±19 yrs; 4 VVI, 7 VDD, 7 VVI-ICD, 20 DDD, 5 DDD-ICD and 11 CRT devices; median time since first implantation: 1558 days [IQR: 470 days – 8.6 yrs]). The infection was caused by streptococci in 3 cases (5.5%), Staphylococci were the most prevalent infective agents (70%), S. aureus (SA) in 28 cases (52%, out of whom 10 were MRSA), coagulase negative Staphylococcus in 10 cases (18.5%), blood culture negative cases in 8 patients (15%), and in 5 cases other pathogens were responsible. 266 patients had LSNIE (201 males [75%], mean age: 54.4 ± 15.6 yrs). There was no difference between the two groups in age or in portion of males. Mortality rates were the same in CDRIE group compared to LSNIE group (30-day: 13% vs 13%, 6-month: 20% vs 25%, 1-year: 26% vs 29% and long-term: 44% vs 44%, ns resp.) Patients who died in the CDRIE group (n = 25) were older (64 yrs [IQR:59-71 yrs] vs 52 yrs [IQR: 27-69 yrs], p = 0.02), male sex was less common (52% vs 79%, p = 0.03), had lower ejection fraction (39.6 ±16.6% vs 54.6 ±14.5%, p < 0.001), had worse renal function (GFR: 46.3 ± 15.3 vs 60.2 ± 23.5 ml/min/1.73m2, p = 0.04), shorter time since first device implantation (2.1 yrs [IQR: 1.1-4.8 yrs] vs 6.7 yrs [4.1-12.9 yrs], p = 0.006), and CRT device implantation were more prevalent (32% vs 10%, p < 0.05). Patients admitted before 2011 (n = 22) did not differ from patients admitted after 2011 (n = 32) in terms of age, male gender, concomitant valve infection, pocket infection, or embolic event. The 30-day (0% vs 6%) and the 1-year mortality (18% vs 31%) were the same before and after 2011, but the 6-month mortality was better before 2011 (4.5% vs 31%, p = 0.01). CRT device implantation was more prevalent over time (5% vs 31%, p = 0.01), and SA infection became more frequent (36% vs 63%, p = 0.05) Conclusions During the last decade patients with CDRIE had a same survival as patients with LSNIE, every fourth patient died one year after the diagnosis. Almost three-quarter of the infections were caused by Staphylococci, and the portion of S. aureus infection increased over time.