title: Cardiac device-related endocarditis: 31-Years' experience.
abstract: BACKGROUND
  Cardiac device-related endocarditis (CDE) is a major complication of the implantation of a pacemaker and defibrillator. The experience in a single high-volume tertiary center is reported.
  
  
  METHODS
  Thirty one years (1980-2011) of cases of CDE were analyzed retrospectively and compared to overall insertion data; the clinical course and management strategies of these patients have been reviewed.
  
  
  RESULTS
  A total of 23 cases (16 male, median age 72 years) were identified, 20 of these cases were determined at our institution where 5287 procedures were performed (endocarditis rate 0.38%). Thirteen patients were determined to have a cardiac device pocket infection. Infection in 7 cases (30%) was caused by lead(s). However, in 16 cases (70%) both leads and the pocket of devices were the reason of infection. Median time was 13.5 months for presentation. Patients who had undergone the last procedure within 6 months were admitted earlier than those with longer post procedure time (p<0.05). Transesophageal echocardiography demonstrated lead vegetations in 13 of the 16 cases (81%). Organisms were identified in 18 cases (78%)-78% Staphylococci (56% Staphylococcus aureus). Leads of the device were removed in 17 cases (74%); seven cases by percutaneous simple traction and 10 cases by sternotomy. Six major complications attributable to device-related endocarditis were observed: four deaths (mortality 17.4%); one splenic abscess requiring splenectomy; and one septic pulmonary embolism; median follow-up 49 months.
  
  
  CONCLUSIONS
  A CDE endocarditis rate of 0.38% was demonstrated. It remains a rare but potentially lethal complication of device implantation.
authors.affiliation: Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul 34668, Turkey. damirbeko@yahoo.com
authors.forename: Damirbek
authors.initials: D
authors.lastname: Osmonov
authors.forename: Kazim Serhan
authors.initials: KS
authors.lastname: Ozcan
authors.forename: Izzet
authors.initials: I
authors.lastname: Erdinler
authors.forename: Servet
authors.initials: S
authors.lastname: Altay
authors.forename: Ersin
authors.initials: E
authors.lastname: Yildirim
authors.forename: Ceyhan
authors.initials: C
authors.lastname: Turkkan
authors.forename: Ahmet
authors.initials: A
authors.lastname: Ekmekci
authors.forename: Baris
authors.initials: B
authors.lastname: Gungor
authors.forename: Kadir
authors.initials: K
authors.lastname: Gurkan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000209:etiology; D002002:Brucella; D017147:Defibrillators, Implantable / Q000009:adverse effects; D020878:Device Removal / Q000009:adverse effects / Q000379:methods; D004452:Echocardiography / Q000379:methods; D004697:Endocarditis, Bacterial / Q000209:etiology; D013293:Enterococcus faecalis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects; D016459:Prosthesis-Related Infections / Q000209:etiology*; D011550:Pseudomonas aeruginosa; D012189:Retrospective Studies; D013210:Staphylococcus; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents