title: Long-term outcomes following infection of cardiac implantable electronic devices: a prospective matched cohort study.
abstract: OBJECTIVE
  To assess long-term outcomes and predictors of mortality in patients treated according to current recommendations for cardiac implantable electronic device (CIED) infection.
  
  
  METHODS
  Two-group matched cohort study.
  
  
  METHODS
  Tertiary-care institution.
  
  
  METHODS
  Consecutive patients admitted for CIED infection between 2004 and 2008 were prospectively enrolled. Study subjects were matched to a cohort of uninfected CIED patients by age, sex and type of device.
  
  
  METHODS
  In all infected patients, the therapeutic approach consisted of complete hardware removal whenever possible, antimicrobial therapy, and implantation of a new device, if indicated. Patients were systematically followed, with standardised outcomes assessment.
  
  
  METHODS
  All-cause mortality and predictors of long-term mortality.
  
  
  RESULTS
  197 patients were included and matched 1:1 to controls. Pocket infections were present in 41.1% and definite or suspected infective endocarditis in 58.9%. Total or subtotal hardware removal was achieved in 98.5% of cases. Median follow up was 25 months (12-70). Mortality rates in the study group and controls were 14.3% vs 11.0% (NS) at 1 year and 35.4% vs 27.0% (p=NS) at 5 years. Independent predictors of long-term mortality were older age (HR=1.09, p<0.001), cardiac resynchronisation therapy (HR=3.70, p=0.001), thrombocytopenia (HR=5.10, p=0.003) and renal insufficiency (HR=2.66, p=0.006). In patients with reimplanted devices, epicardial right ventricular pacemakers were associated with higher mortality (HR=2.85, p=0.034).
  
  
  CONCLUSIONS
  In patients with CIED infection managed by recommended therapy, long-term mortality rates are similar to comparable controls. Independent predictors include patient and disease-related factors, in addition to implantation of right ventricular epicardial pacemakers.
authors.affiliation: Cardiology Department, CHU La Timone, Medical School of Marseilles, Marseilles, France. jean-claude.deharo@ap-hm.fr
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Deharo
authors.forename: Amandine
authors.initials: A
authors.lastname: Quatre
authors.forename: Julien
authors.initials: J
authors.lastname: Mancini
authors.forename: Paul
authors.initials: P
authors.lastname: Khairy
authors.forename: Yvan
authors.initials: Y
authors.lastname: Le Dolley
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Casalta
authors.forename: Eric
authors.initials: E
authors.lastname: Peyrouse
authors.forename: Sébastien
authors.initials: S
authors.lastname: Prévôt
authors.forename: Franck
authors.initials: F
authors.lastname: Thuny
authors.forename: Frédéric
authors.initials: F
authors.lastname: Collart
authors.forename: Didier
authors.initials: D
authors.lastname: Raoult
authors.forename: Gilbert
authors.initials: G
authors.lastname: Habib
authors.forename: Frédéric
authors.initials: F
authors.lastname: Franceschi
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001145:Arrhythmias, Cardiac / Q000628:therapy; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D020878:Device Removal / Q000379:methods*; D004697:Endocarditis, Bacterial / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D018570:Risk Assessment / Q000379:methods*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents