title: Cardiac implantable electronic device-related endocarditis: a 12-year single-centre experience.
abstract: BACKGROUND
  The incidence of cardiac implantable electrical device endocarditis (CIEDE) is increasing, but CIEDE remains a relatively poorly described infection. This case series describes our experience of the condition at a tertiary referral centre in London over a 12-y period.
  
  
  METHODS
  We identified cases using an endocarditis database containing prospectively collected clinical and microbiological information. We also used data recorded in an electronic database of all cardiac implantable electrical device-related procedures.
  
  
  RESULTS
  Thirty cases of CIEDE were treated at our institution during the study period. Presentation was most commonly with fever, and 93% of our patients had positive blood cultures. Vegetations were identified on echocardiography in only 70% of patients, although a transoesophageal echocardiogram (TOE) was performed in only half of the cases. Sixty-seven percent of our cases were defined as definite endocarditis according to the modified Duke criteria for infective endocarditis. Twenty-three patients underwent percutaneous explantation of their infected CIED (including 6 patients with vegetations greater than 10 mm in diameter), while 5 underwent surgical explantation. The overall in-hospital mortality was 17%.
  
  
  CONCLUSIONS
  Our data confirm the life-threatening nature of CIEDE in a UK population. In addition, our experience suggests that percutaneous extraction of devices with large adherent vegetations may be safe, and that the selective use of TOE may not compromise outcomes. Lastly, we show that the modified Duke criteria do not perform very well with this condition, suggesting a need for specific, validated criteria for diagnosing CIEDE.
authors: Cardiothoracic Centre and Directorate of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors: John
authors: J
authors: Whitaker
authors: Steven
authors: S
authors: Williams
authors: Aruna
authors: A
authors: Arujuna
authors: C Aldo
authors: CA
authors: Rinaldi
authors: John
authors: J
authors: Chambers
authors: John L
authors: JL
authors: Klein
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004696:Endocarditis / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D004864:Equipment and Supplies / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D016019:Survival Analysis; D062606:Tertiary Care Centers; D055815:Young Adult