title: Clinical characteristics and outcome of infective endocarditis involving implantable cardiac devices.
abstract: BACKGROUND
  Infection of implantable cardiac devices is an emerging disease with significant morbidity, mortality, and health care costs.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of Infectious Diseases, Barwon Health, Geelong, Australia.
authors.forename: Eugene
authors.initials: E
authors.lastname: Athan
authors.forename: Vivian H
authors.initials: VH
authors.lastname: Chu
authors.forename: Pierre
authors.initials: P
authors.lastname: Tattevin
authors.forename: Christine
authors.initials: C
authors.lastname: Selton-Suty
authors.forename: Phillip
authors.initials: P
authors.lastname: Jones
authors.forename: Christoph
authors.initials: C
authors.lastname: Naber
authors.forename: José M
authors.initials: JM
authors.lastname: Miró
authors.forename: Salvador
authors.initials: S
authors.lastname: Ninot
authors.forename: Nuria
authors.initials: N
authors.lastname: Fernández-Hidalgo
authors.forename: Emanuele
authors.initials: E
authors.lastname: Durante-Mangoni
authors.forename: Denis
authors.initials: D
authors.lastname: Spelman
authors.forename: Bruno
authors.initials: B
authors.lastname: Hoen
authors.forename: Tatjana
authors.initials: T
authors.lastname: Lejko-Zupanc
authors.forename: Enrico
authors.initials: E
authors.lastname: Cecchi
authors.forename: Franck
authors.initials: F
authors.lastname: Thuny
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Hannan
authors.forename: Paul
authors.initials: P
authors.lastname: Pappas
authors.forename: Margaret
authors.initials: M
authors.lastname: Henry
authors.forename: Vance G
authors.initials: VG
authors.lastname: Fowler
authors.forename: Anna Lisa
authors.initials: AL
authors.lastname: Crowley
authors.forename: Andrew
authors.initials: A
authors.lastname: Wang
mesh_terms: D000368:Aged; D003428:Cross Infection / Q000209:etiology / Q000401:mortality; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D020878:Device Removal; D004696:Endocarditis / Q000209:etiology* / Q000401:mortality*; D005260:Female; D006349:Heart Valve Diseases / Q000209:etiology / Q000401:mortality; D017052:Hospital Mortality / Q000639:trends*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D015995:Prevalence; D011446:Prospective Studies; D013203:Staphylococcal Infections / Q000209:etiology / Q000401:mortality; D016019:Survival Analysis; D016896:Treatment Outcome; D014261:Tricuspid Valve