Cardiac Implant Infections Linked to Significant Morbidity

A new study has found that patients with cardiac device infective endocarditis (CDIE) have a high rate of mortality and morbidity, and appear to benefit from early device removal.

Researchers at Duke University Medical Center (Duke; Durham, NC, USA), the University of New South Wales (Sydney, Australia), and 59 other institutions in 28 countries conducted a prospective cohort study using data from the International Collaboration on Endocarditis–Prospective Cohort Study (ICE-PCS), conducted from June 2000 through August 2006. The participants were hospitalized adults with definite endocarditis, as defined by modified Duke endocarditis criteria. The main outcome measures were in-hospital and one-year mortality, and the association between device removal during index hospitalization and outcome.

The results showed that CDIE was diagnosed in 177 of a total cohort of 2,760 patients with definite infective endocarditis; in-hospital and one-year mortality rates were 14.7% and 23.2%, respectively. The clinical profile of CDIE included advanced patient age (median age 71.2 years), causation by staphylococci (42.5% Staphylococcus aureus and 31.6% coagulase-negative staphylococci), and a high prevalence of health care associated infection. There was coexisting valve involvement in 66 (37.3%) of the patients, predominantly tricuspid valve infection, with associated higher mortality. A survival benefit at one year was found for device removal during the initial hospitalization (19.9%), compared to those who did not undergo device removal (38.2%). The study was published in the April 25, 2012, issue of the Journal of the American Medical Association (JAMA).

“The high rates of mortality emphasize the need for improved preventive measures, including optimal skin decontamination and appropriate antibiotic administration at the time of cardiac device insertion or manipulation, as well as careful attention to any invasive or intravascular procedures performed after device implantation,” concluded study coauthor Andrew Wang, MD, of Duke, and colleagues. “Given that numbers of cardiovascular implantable electronic devices placed are increasing rapidly, further studies on the prevention and treatment of device-related infective endocarditis are needed.”

Related Links:
Duke University Medical Center
University of New South Wales