title: Clinical features and changes in epidemiology of infective endocarditis on pacemaker devices over a 27-year period (1987-2013).
abstract: OBJECTIVE
  Use of cardiac pacing devices has grown in recent years. Our aim was to evaluate changes in epidemiology and clinical features of infective endocarditis (IE) involving pacemaker devices in a large series of IE over the last 27 years (1987-2013).
  
  
  RESULTS
  From 1987 to December 2013, 413 consecutive IE cases were diagnosed in our hospital. During this period, 7424 pacemaker devices were implanted (6917 pacemakers, 239 implantable cardiac defibrillators, 158 resynchronization devices, and 110 resynchronization/defibrillator devices). All consecutive cases of IE on pacemaker devices were included and analysed. Infective endocarditis on pacemaker devices represented 6.1% of all endocarditis cases (25 patients), affecting 3.6/1000 of all implanted pacemakers. Its proportion increased from 1.25% of all endocarditis in 1987-1993 to 4.08% in 1994-2000, 7.69% in 2001-2007 and 9.32% in 2008-2013 (P < 0.01). Its incidence also increased from 1.4/1000 of all pacemaker implants in the period of 1987-1993 to 2.5/1000 in 1994-2000, 3.3/1000 in 2001-2007 and 4.5/1000 implanted devices in 2008-2013 (P < 0.05). Mean age of patients was 68 years, and 80% were male. Causative microorganisms predominantly were Staphylococci (84%: Staphylococcus aureus 48%, Staphylococcus epidermidis 36%). Rate of severe complications was high: persistent sepsis in 60% of cases, heart failure in 20%, and stroke in 12%. Device was removed in 19 patients (76%), mostly by surgery (18 of the 19 cases). Early mortality was 24% (33% of medically, 21% of surgically treated patients, P = 0.82).
  
  
  CONCLUSIONS
  Infective endocarditis on pacemaker devices has shown an increasing incidence during the past decades, representing almost 10% of all IE in the last 6 years. This is a severe disease, with a high rate of severe complications and requiring removal of device in most cases. In spite of therapy, early mortality is high.
authors.affiliation: Department of Cardiology, Reina Sofía University Hospital, Córdoba, Spain carrasco.avalos@gmail.com.
authors.forename: Francisco
authors.initials: F
authors.lastname: Carrasco
authors.affiliation: Department of Cardiology, Reina Sofía University Hospital, Córdoba, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Anguita
authors.affiliation: Department of Cardiology, Reina Sofía University Hospital, Córdoba, Spain.
authors.forename: Martín
authors.initials: M
authors.lastname: Ruiz
authors.affiliation: Department of Cardiology, Reina Sofía University Hospital, Córdoba, Spain.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Castillo
authors.affiliation: Department of Cardiology, Reina Sofía University Hospital, Córdoba, Spain.
authors.forename: Mónica
authors.initials: M
authors.lastname: Delgado
authors.affiliation: Department of Cardiology, Reina Sofía University Hospital, Córdoba, Spain.
authors.forename: Dolores
authors.initials: D
authors.lastname: Mesa
authors.affiliation: Department of Cardiology, Reina Sofía University Hospital, Córdoba, Spain.
authors.forename: Elias
authors.initials: E
authors.lastname: Romo
authors.affiliation: Department of Cardiology, Reina Sofía University Hospital, Córdoba, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Pan
authors.affiliation: Department of Cardiology, Reina Sofía University Hospital, Córdoba, Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: Suárez de Lezo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017147:Defibrillators, Implantable / Q000009:adverse effects* / Q000706:statistics & numerical data; D020878:Device Removal / Q000706:statistics & numerical data; D004697:Endocarditis, Bacterial / Q000453:epidemiology*; D005260:Female; D006333:Heart Failure / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects* / Q000706:statistics & numerical data; D016459:Prosthesis-Related Infections / Q000453:epidemiology*; D013030:Spain
chemical_list: D000900:Anti-Bacterial Agents
keywords: Cardiac resynchronization therapy; Device; Endocarditis; Implantable cardioverter-defibrillator; Infective endocarditis; Pacemaker