Infective endocarditis in patients with cardiac implantable electronic devices: a nationwide study

Gaitán, Roberto Mateos; Boix-Palop, Lucía; García, Patricia; Mestres, Carlos A.; Arriaza, Mercedes Marín; Prieto, A.; González, Arístides de Alarcón; Carretero, Encarnación Gutiérrez; Hernández‐Meneses, Marta; Sánchez, Miguel Ángel Goenaga; Belaustegui, Manuel Cobo; Oteo, José A.; Arana, Juan Carlos Gainzarain; Vázquez, Elisa García; Martínez‐Sellés, Manuel

doi:10.1093/europace/euaa076

Cited by 36 publications

(18 citation statements)

References 21 publications

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“…A recent study described that 18% of patients with IE had a previously implanted CIED, of whom the majority had CIED-related IE. 64 Therefore, CIED infections should always be suspected in CIED patients with IE, and CIED removal is usually recommended. 10 …”

Section: Discussionmentioning

confidence: 99%

Risk factors for cardiac implantable electronic device infections: a nationwide Danish study

Olsen

Jørgensen

Nielsen

et al. 2022

European Heart Journal

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Aims Cardiac implantable electronic device (CIED) infection is a severe complication to modern management of cardiac arrhythmias. The CIED type and the type of surgery are recognized as risk factors for CIED infections, but knowledge of patient-related risk factors is scarce. This study aimed to identify lifelong patient-related risk factors for CIED infections. Methods and results Consecutive Danish patients undergoing a CIED implantation or reoperation between January 1996 and April 2018 were included. The cohort consisted of 84 429 patients undergoing 108 494 CIED surgeries with a combined follow-up of 458 257 CIED-years. A total of 1556 CIED explantations were classified as either pocket (n = 1022) or systemic CIED infection (n = 534). Data were cross-linked with records from the Danish National Patient Registry and the Danish National Prescription Registry. Using multiple-record and multiple-event per subject proportional hazard analysis, specific patient-related risk factors were identified but with several variations amongst the subtypes of CIED infection. CIED reoperations were associated with the highest risk of pocket CIED infection but also CIED type, young age, and prior valvular surgery [hazard ratio (HR): 1.62, 95% confidence interval (CI): 1.29–2.04]. Severe renal insufficiency/dialysis (HR: 2.40, 95% CI: 1.65–3.49), dermatitis (HR: 2.80, 95% CI: 1.92–4.05), and prior valvular surgery (HR: 2.09, 95% CI: 1.59–2.75) were associated with the highest risk of systemic CIED infections. Congestive heart failure, ischaemic heart disease, malignancy, chronic obstructive pulmonary disease, and temporary pacing were not significant at multivariate analysis. Conclusion Specific comorbidities and surgical procedures were associated with a higher risk of CIED infections but with variations amongst pocket and systemic CIED infection. Pocket CIED infections were associated with CIED reoperations, young age and more complex type of CIED, whereas systemic CIED infections were associated with risk factors predisposing to bacteraemia.

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Section: Discussionmentioning

confidence: 99%

Risk factors for cardiac implantable electronic device infections: a nationwide Danish study

Olsen

Jørgensen

Nielsen

et al. 2022

European Heart Journal

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“…The characteristics of the GAMES (Grupos de Apoyo para el Manejo de la Endocarditis en ESpaña) cohort, collection of data variables through a specific central registration depository (CRD), and general definitions are described elsewhere [ 12 , 13 ]. Sepsis and septic shock developing once patients were admitted to the hospital and occurring before cardiac surgery were prospectively collected in the GAMES CRD by physicians in charge of the Endocarditis Team in each collaborating center according to definitions by international consensus in place [ 14 ].…”

Section: Methodsmentioning

confidence: 99%

Outcomes and Risk Factors of Septic Shock in Patients With Infective Endocarditis: A Prospective Cohort Study

Pericàs

Hernández‐Meneses

Muñóz

et al. 2021

Open Forum Infectious Diseases

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Background Little is known about the characteristics and impact of septic shock (SS) on the outcomes of infective endocarditis (IE). We aimed to investigate the characteristics and outcomes of patients with IE presenting with SS and to compare them to those of IE patients with sepsis (Se) and those with neither Se nor SS (no-Se-SS). Methods Prospective cohort study of 4,864 IE patients from 35 Spanish centers (2008 to 2018). Logistic regression analyses were performed to identify risk factors for SS and mortality. Results SS and Se presented respectively in 597 (12.3%) and 559 (11.5%) patients. Patients with SS were younger and presented significantly higher rates of diabetes, chronic renal and liver disease, transplantation, nosocomial acquisition, S.aureus, IE complications, and in-hospital mortality (62.5%, 37.7% for Se and 18.2% for no-Se-SS,p<.001). S.aureus (OR 1.94, 95%CI 1.34-2.81,p<.001), Gram negative (OR 2.21,95%CI 1.25-3.91,p.006), nosocomial acquisition (OR 1.44,95%CI 1.07-1.94,p.015), persistent bacteremia (OR 1.82, 95%CI 1.24-2.68,p.002), acute renal failure (OR 3.02,95% 2.28-4.01,p<.001), CNS emboli (OR 1.48,1.08-2.01,p.013), and larger vegetation size (OR 1.01,95%CI 1.00-1.02,p.020) were associated with a higher risk of developing SS. Charlson score, heart failure, persistent bacteremia, acute renal failure, mechanical ventilation, worsening of liver disease, S.aureus and receiving aminoglycosides within the first 24h were associated with higher in-hospital mortality, whereas male sex, native valve IE and cardiac surgery were associated with lower mortality. Conclusions SS is frequent and entails dismal prognosis. Early identification of patients at risk of developing SS and early assessment for cardiac surgery appear as key factors to improve outcomes.

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“…Compared to the past, there is a decline in coagulase-negative staphylococcus infections (27%), with the emergence of S. Aureus as the primary cause of CIED-IE (38%). The frequent infectious agents are other gram-positive cocci at 21% (mainly streptococci 12% and enterococci 5%) [ 40 , 41 ].…”

Section: Microbiological Burden Of Infective Endocarditis: a Changing...mentioning

confidence: 99%

Current Views on Infective Endocarditis: Changing Epidemiology, Improving Diagnostic Tools and Centering the Patient for Up-to-Date Management

Cimmino

Bottino

Formisano

et al. 2023

Life

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Infective endocarditis (IE) is a rare but potentially life-threatening disease, sometimes with longstanding sequels among surviving patients. The population at high risk of IE is represented by patients with underlying structural heart disease and/or intravascular prosthetic material. Taking into account the increasing number of intravascular and intracardiac procedures associated with device implantation, the number of patients at risk is growing too. If bacteremia develops, infected vegetation on the native/prosthetic valve or any intracardiac/intravascular device may occur as the final result of invading microorganisms/host immune system interaction. In the case of IE suspicion, all efforts must be focused on the diagnosis as IE can spread to almost any organ in the body. Unfortunately, the diagnosis of IE might be difficult and require a combination of clinical examination, microbiological assessment and echocardiographic evaluation. There is a need of novel microbiological and imaging techniques, especially in cases of blood culture-negative. In the last few years, the management of IE has changed. A multidisciplinary care team, including experts in infectious diseases, cardiology and cardiac surgery, namely, the Endocarditis Team, is highly recommended by the current guidelines.

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Infective endocarditis in patients with cardiac implantable electronic devices: a nationwide study

Abstract: Abstract Aims Patients with infective endocarditis (IE) frequently have cardiac implantable electronic devices (CIEDs). Here, we aim to define the clinical profile and prognostic factors of IE in these patients. Methods and results Infective endocarditis cases wer… Show more

Cited by 36 publications

References 21 publications

Risk factors for cardiac implantable electronic device infections: a nationwide Danish study

Risk factors for cardiac implantable electronic device infections: a nationwide Danish study

Outcomes and Risk Factors of Septic Shock in Patients With Infective Endocarditis: A Prospective Cohort Study

Current Views on Infective Endocarditis: Changing Epidemiology, Improving Diagnostic Tools and Centering the Patient for Up-to-Date Management

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