[en] AIMS: Cardiac device-related infective endocarditis (CDRIE) is a severe complication of cardiac device (CD) implantation and is usually treated by antibiotic therapy and percutaneous device extraction. Few studies report the management and prognosis of CDRIE in real life. In particular, the rate of device extraction in clinical practice and the management of patients with left heart infective endocarditis (LHIE) and an apparently non-infected CD (LHIE+CDRIE-) are not well described. METHODS AND RESULTS: We sought to study in EURO-ENDO, the characteristics, prognosis, and management of 483 patients with a CD included in the European Society of Cardiology EurObservational Research Programme EURO-ENDO registry. Three populations were compared: 280 isolated CDRIE (66.7 ± 14.3 years), 157 patients with LHIE and an apparently non-infected CD (LHIE+CDRIE-) (71.1 ± 13.6), and 46 patients with both LHIE and CDRIE (LHIE+CDRIE+) (70.2 ± 10.1). Echocardiography was not always transoesophageal echography (TOE); it was transthoracic echography (TTE) for isolated CDRIE in 88.4% (TOE = 67.6%), for LHIE+CDRIE- TTE = 93.0% (TOE = 58.6%), and for CDRIE+LHIE+ TTE = 87.0% (TOE = 63.0%). Nuclear imaging was performed in 135 patients (positive for 75.6%). In-hospital mortality was lower in isolated CDRIE 13.2% vs. 22.3% and 30.4% for LHIE+CDRIE- and LHIE+CDRIE+ (P = 0004). Device extraction was performed in 62.1% patients with isolated CDRIE, 10.2% of LHIE+CDRIE- patients, and 45.7% of CDRIE+LHIE+ patients. Device extraction was associated with a better prognosis [hazard ratio 0.59 (0.40-0.87), P = 0.0068] even in the LHIE+CDRIE- group (P = 0.047). CONCLUSION: Prognosis of endocarditis in patients with a CD remains poor, particularly in the presence of an associated LHIE. Although recommended by guidelines, device extraction is not always performed. Device removal was associated with better prognosis, even in the LHIE+CDRIE- group.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Donal, Erwan ; Cardiologie, CHU de RENNES, LTSI UMR1099, INSERM, Université de Rennes-1, hopital pontchaillou, 35000 Rennes, France.
Tribouilloy, Christophe ; Department of Cardiology, Amiens University Hospital Amiens, Amiens 80000, France.
Sadeghpour, Anita ; Echocardiography Research Centre, Rajaie Cardiovascular Medical and Research Centre, Iran University of Medical Sciences, Tehran, Iran.
Laroche, Cécile; European Society of Cardiology, EORP, Sophia-Antipolis, France.
Tude Rodrigues, Ana Clara; servico de Echocardiografia-InRad-HC-Faculdade de Medicina, Universidade de Sao Paulo, SP, Brazil.
Pereira Nunes, Maria do Carmo; Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
Kang, Duk-Hyun ; Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap-dong, Songpa-gu, Seoul 138-736, Korea.
Hernadez-Meneses, Marta ; Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
Kobalava, Zhanna ; Department of Cardiology, RUDN Univerisity, Moscow, Russia.
De Bonis, Michele ; Cardiac Surgery, Innovation and Research, 'Vita-Salute' San Raffaele University Hospital, Milan 20132, Italy.
Dworakowski, Rafal ; Department of Cardiology, Kings College Hospital and King's College London, Denmark Hill, London SE5 9RS, UK.
Ivanovic, Branislava ; Clinical Center of Serbia, Clinic of Cardiology, Belgrade, Serbia.
Holicka, Maria ; Department of Cardiology, University Hospital Brno, Jihlavska 20, Brno 62500, Czech Republic.
Kitai, Takeshi ; Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.
Cruz, Ines ; Departamento de Cardiologia, Hospital Garcia de Orta, Almada, Portugal.
Huttin, Olivier ; F-CRIN INI-CRCT Cardiovascular and Renal Clinical Trialists Network, INSERM 1116, CHRU de Nancy, Nancy, France.
Colonna, Paolo ; Department of Cardiology, Polyclinic of Bari-Hospital, Bari 70124, Italy.
Lancellotti, Patrizio ; Centre Hospitalier Universitaire de Liège - CHU > > Service de cardiologie ; Department of Cardiology, Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy.
Habib, Gilbert ; APHM, Cardiology Department, La Timone Hospital, Marseille, France. ; IRD, APHM, MEPHI, IHU-Méditerranée Infection, Aix Marseille University, Marseille, France.
Kusumoto FM, Schoenfeld MH, Wilkoff BL, Berul CI, Birgersdotter-Green UM, Carrillo R, Cha Y-M, Clancy J, Deharo J-C, Ellenbogen KA, Exner D, Hussein AA, Kennergren C, Krahn A, Lee R, Love CJ, Madden RA, Mazzetti HA, Moore JC, Parsonnet J, Patton KK, Rozner MA, Selzman KA, Shoda M, Srivathsan K, Strathmore NF, Swerdlow CD, Tompkins C, Wazni O. 2017 HRS expert consensus statement on cardiovascular implantable electronic device lead management and extraction. Heart Rhythm 2017;14: e503–ee51.
Baddour LM, Epstein AE, Erickson CC, Knight BP, Levison ME, Lockhart PB, Masoudi FA, Okum EJ, Wilson WR, Beerman LB, Bolger AF, Estes NAM, Gewitz M, Newburger JW, Schron EB, Taubert KA. Update on cardiovascular implantable electronic device infections and their management: a scientific statement from the American heart association. Circulation 2010;121:458–477.
Deshmukh A, Patel N, Noseworthy PA, Patel AA, Patel N, Arora S, Kapa S, Noheria A, Mulpuru S, Badheka A, Fischer A, Coffey JO, Cha YM, Friedman P, Asirvatham S, Viles-Gonzalez JF. Trends in use and adverse outcomes associated with transvenous lead removal in the United States. Circulation 2015;132:2363–2371.
Sohail MR, Eby EL, Ryan MP, Gunnarsson C, Wright LA, Greenspon AJ. Incidence, treatment intensity, and incremental annual expenditures for patients experiencing a cardiac implantable electronic device infection: evidence from a large US payer database 1-year post implantation. Circ Arrhythmia Electrophysiol 2016;9:e003929.
Habib G, Lancellotti P, Iung B. 2015 ESC guidelines on the management of infective endocarditis: a big step forward for an old disease. Heart 2016;102:992–994.
Rigau PV, Moral S, Bosch D, Morales M, Frigola JM, Albert X, Robles R, Ballesteros E, Roqué M, Aboal J, Brugada R. Clinical prognosis of right-sided infective endocarditis not associated with cardiac devices or intravenous drug use: a cohort study and meta-analysis. Sci Rep 2020;10:7179.
Habib G, Erba PA, Iung B, Donal E, Cosyns B, Laroche C, Popescu BA, Prendergast B, Tornos Pilar, Sadeghpour A, Oliver L, Vaskelyte J-J, Sow R, Axler O, Maggioni AP, Lancellotti P, Gale CP, Beleslin B, Budaj A, Chioncel O, Dagres N, Danchin N, Emberson J, Erlinge D, Glikson M, Gray A, Kayikcioglu M, Maggioni A P, Nagy VK, Nedoshivin A, Petronio A-S, Roos-Hesselink J, Wallentin L, Zeymer U, Habib G, Lancellotti P; EURO-ENDO Investigators. Clinical presentation, aetiology and outcome of infective endocarditis. Results of the ESC-EORP EURO-ENDO (European infective endocarditis) registry: a prospective cohort study. Eur Heart J 2019;40:3222–3232.
Habib G, Lancellotti P, Erba PA, Sadeghpour A, Meshaal M, Sambola A, Furnaz S, Citro R, Ternacle J, Donal E, Cosyns B, Popescu B, Iung B, Prendergast B, Laroche C, Tornos P, Pazdernik M, Maggioni A, Gale CP; EURO-ENDO Investigators. The ESC-EORP EURO-ENDO (European Infective Endocarditis) registry. Eur Heart J Qual Care Clin Outcomes 2019;5:202–207.
Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, Dulgheru R, Khoury GE, Erba PA, Iung B, Miro JM, Mulder BJ, Plonska-Gosciniak E, Price S, Roos-Hesselink J, Snygg-Martin U, Thuny F, Mas PT, Vilacosta I, Zamorano JL. 2015 ESC guidelines for the management of infective endocarditis: the Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 2015;36:3075–3128.
Dumont E, Camus C, Victor F, de Place C, Pavin D, Alonso C, Mabo P, Daubert JC. Suspected pacemaker or defibrillator transvenous lead infection. Prospective assessment of a TEE-guided therapeutic strategy. Eur Heart J 2003;24:1779–1787.
Camus C, Donal E, Bodi S, Tattevin P. Pacemaker and implantable cardioverter defibrillator infections. Med Mal Infect 2010;40:429–439.
Gaitan R M, Boix-Palop L, Munoz Garcia P, Mestres CA, Marin Arriaza M, Pedraz Prieto A, Boix-Palop L, Muñoz García P, Mestres CA, Marín Arriaza M, Pedraz Prieto Á, de Alarcón Gonzalez A, Gutiérrez Carretero E, Hernández Meneses M, Goenaga Sánchez MÁ, Cobo Belaustegui M, Oteo Revuelta JA, Gainzarain Arana JC, García Vázquez E, Martínez-Sellés M. Infective endocarditis in patients with cardiac implantable electronic devices: a nationwide study. Europace 2020;22:1062–1070.
Urien JM, Camus C, Leclercq C, Dejoies L, Mabo P, Martins R, Boukthir S, Bénézit F, Behar N, Revest M, Bodi S, Bila J, Donal E, Tattevin P. The emergence of Staphylococcus aureus as the primary cause of cardiac device–related infective endocarditis. Infection 2021;49:999–1006.
Pazdernik M, Iung B, Mutlu B, Alla F, Riezebos R, KongLa W, Nunes MCP, Pierard L, Srdanovic I, Yamada H, De Martino A, Miglioranza MH, Magne J, Piper C, roche C, Maggioni AP, Lancellotti P, Habib G, Selton-Suty C; EURO-ENDO Investigators. Surgery and outcome of infective endocarditis in octogenarians: prospective data from the ESC EORP EURO-ENDO registry. Infection 2022;50:1191–1202.
Kong WKF, Salsano A, Giacobbe DR, Popescu BA, Laroche C, Duval X, Schueler Robert, Moreo A, Colonna P, Piper C, Calvo-Iglesias F, Badano LP, Srdanovic I, Boutoille D, Huttin O, Stöhr E, Timóteo AT, Vaskelyte JJ, Sadeghpour A, Tornos P, Abid L, Poh KK, Habib G, Lancellotti P, Habib G. Outcomes of culture-negative vs. Culture-positive infective endocarditis: the ESC-EORP EURO-ENDO registry. Eur Heart J 2022;43:2770–2780.
De Ciancio G, Erpelding ML, Filippetti L, Goehringer F, Blangy H, Huttin O, Agrinier N, Juillière Y, Sadoul N, Selton-Suty C. Adherence to diagnostic and therapeutic practice guidelines for suspected cardiac implantable electronic device infections. Arch Cardiovasc Dis 2021;114:634–646.
Selton-Suty C, Celard M, Le Moing V, Doco-Lecompte T, Chirouze C, Iung B, Strady C, Revest M, Vandenesch F, Bouvet A, Delahaye F, Alla F, Duval X, Hoen B. Preeminence of Staphylococcus aureus in infective endocarditis: a 1-year population-based survey. Clin Infect Dis 2012;54:1230–1239.
Fowler VG Jr, Miro JM, Hoen B, Cabell CH, Abrutyn E, Rubinstein E, Corey GR, Spelman D, Bradley SF, Barsic B, Pappas PA, Anstrom KJ, Wray D, Fortes CQ, Anguera I, Athan E, Jones P, van der Meer JTM, Elliott TSJ, Levine DP, Bayer AS; ICE Investigators. Staphylococcus aureus endocarditis: a consequence of medical progress. Jama 2005; 293:3012–3021.
Murdoch DR, Corey GR, Hoen B, Miro JM, Fowler VG, Bayer AS, Karchmer AW, Olaison L, Pappas PA, Moreillon P, Chambers ST, Chu VH, Falcó V, Holland DJ, Jones P, Klein JL, Raymond NJ, Read KM, Tripodi MF, Utili R, Wang A, Woods CW, Cabell CH; International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS) Investigators. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study. Arch Intern Med 2009;169:463–473.
Sengupta SP, Prendergast B, Laroche C, Furnaz S, Ronderos R, Almaghraby A, Asch FM, Blechova K, Zaky H, Strahilevitz J, Dworakowski R, Miyasaka Y, Sebag I, Izumi C, Axler O, Jamiel A, Philip M, Campos Vieira ML, Lancellotti P, Habib G. Socioeconomic variations determine the clinical presentation, aetiology, and outcome of infective endocarditis: a prospective cohort study from the ESC-EORP EURO-ENDO (European Infective Endocarditis) registry. Eur Heart J Qual Care Clin Outcomes 2022;9:85–96.
Sifaoui I, Oliver L, Tacher V, Fiore A, Lepeule R, Moussafeur A, Huguet R, Teiger E, Audureau E, Derbel H, Luciani A, Kobeiter H, Lim P, Ternacle J, Deux J-F. Diagnostic performance of transesophageal echocardiography and cardiac computed tomography in infective endocarditis. J Am Soc Echocardiogr 2020;33:1442–1453.
Rohacek M, Baddour LM. Cardiovascular implantable electronic device infections: associated risk factors and prevention. Swiss Med Wkly 2015;145:w14157.
Sandoe JA, Barlow G, Chambers JB, Gammage M, Guleri A, Howard P, Spry M. J., Steeds R. P, Tayebjee M. H., Watkin R; British Society for Antimicrobial Chemotherapy, British Heart Rhythm Society; British Cardiovascular Society, British Heart Valve Society; British Society for Echocardiography. Guidelines for the diagnosis, prevention and management of implantable cardiac electronic device infection. Report of a joint working party project on behalf of the British Society for Antimicrobial Chemotherapy (BSAC, host organization), British Heart Rhythm Society (BHRS), British Cardiovascular Society (BCS), British Heart Valve Society (BHVS) and British Society for Echocardiography (BSE). J Antimicrob Chemotherapy 2015;70:325–359.
