TY - JOUR
T1 - Timing of the most recent device procedure influences the clinical outcome of lead-associated endocarditis
T2 - Results of the MEDIC (Multicenter Electrophysiologic Device Infection Cohort)
AU - Greenspon, Arnold J.
AU - Prutkin, Jordan M.
AU - Sohail, Muhammad R.
AU - Vikram, Holenarasipur R.
AU - Baddour, Larry M.
AU - Danik, Stephan B.
AU - Peacock, James
AU - Falces, Carlos
AU - Miro, Jose M.
AU - Blank, Elisabeth
AU - Naber, Christoph
AU - Carrillo, Roger G.
AU - Tseng, Chi Hong
AU - Uslan, Daniel Z.
N1 - Funding Information:
This study was funded, in part, by a grant from the American Heart Association (Dr. Uslan, Primary Investigator). Dr. Greenspon has received speaker honoraria from Medtronic, Boston Scientific, and St. Jude Medical. Dr. Sohail is a consultant to TyRx. Dr. Carrillo is a consultant to Spectranetics; is on the Speaker's Bureau of St. Jude Medical and Boston Scientific; and is the recipient of a research grant from St. Jude Medical . Dr. Uslan is a consultant to Medtronic and TyRx; and has received honoraria from Biotronik. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
PY - 2012/2/14
Y1 - 2012/2/14
N2 - Objectives: The purpose of this study was to determine whether the timing of the most recent cardiac implantable electronic device (CIED) procedure, either a permanent pacemaker or implantable cardioverter-defibrillator, influences the clinical presentation and outcome of lead-associated endocarditis (LAE). Background: The CIED infection rate has increased at a time of increased device use. LAE is associated with significant morbidity and mortality. Methods: The clinical presentation and course of LAE were evaluated by the MEDIC (Multicenter Electrophysiologic Device Cohort) registry, an international registry enrolling patients with CIED infection. Consecutive LAE patients enrolled in the Multicenter Electrophysiologic Device Cohort registry between January 2009 and May 2011 were analyzed. The clinical features and outcomes of 2 groups were compared based on the time from the most recent CIED procedure (early, <6 months; late, >6 months). Results: The Multicenter Electrophysiologic Device Cohort registry entered 145 patients with LAE (early = 43, late = 102). Early LAE patients presented with signs and symptoms of local pocket infection, whereas a remote source of bacteremia was present in 38% of patients with late LAE but only 8% of early LAE (p < 0.01). Staphylococcal species were the most frequent pathogens in both early and late LAE. Treatment consisted of removal of all hardware and intravenous administration of antibiotics. In-hospital mortality was low (early = 7%, late = 6%). Conclusions: The clinical presentation of LAE is influenced by the time from the most recent CIED procedure. Although clinical manifestations of pocket infection are present in the majority of patients with early LAE, late LAE should be considered in any CIED patient who presents with fever, bloodstream infection, or signs of sepsis, even if the device pocket appears uninfected. Prompt recognition and management may improve outcomes.
AB - Objectives: The purpose of this study was to determine whether the timing of the most recent cardiac implantable electronic device (CIED) procedure, either a permanent pacemaker or implantable cardioverter-defibrillator, influences the clinical presentation and outcome of lead-associated endocarditis (LAE). Background: The CIED infection rate has increased at a time of increased device use. LAE is associated with significant morbidity and mortality. Methods: The clinical presentation and course of LAE were evaluated by the MEDIC (Multicenter Electrophysiologic Device Cohort) registry, an international registry enrolling patients with CIED infection. Consecutive LAE patients enrolled in the Multicenter Electrophysiologic Device Cohort registry between January 2009 and May 2011 were analyzed. The clinical features and outcomes of 2 groups were compared based on the time from the most recent CIED procedure (early, <6 months; late, >6 months). Results: The Multicenter Electrophysiologic Device Cohort registry entered 145 patients with LAE (early = 43, late = 102). Early LAE patients presented with signs and symptoms of local pocket infection, whereas a remote source of bacteremia was present in 38% of patients with late LAE but only 8% of early LAE (p < 0.01). Staphylococcal species were the most frequent pathogens in both early and late LAE. Treatment consisted of removal of all hardware and intravenous administration of antibiotics. In-hospital mortality was low (early = 7%, late = 6%). Conclusions: The clinical presentation of LAE is influenced by the time from the most recent CIED procedure. Although clinical manifestations of pocket infection are present in the majority of patients with early LAE, late LAE should be considered in any CIED patient who presents with fever, bloodstream infection, or signs of sepsis, even if the device pocket appears uninfected. Prompt recognition and management may improve outcomes.
KW - endocarditis
KW - implantable cardioverter-defibrillator
KW - permanent pacemaker
UR - http://www.scopus.com/inward/record.url?scp=84856979700&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2011.11.011
DO - 10.1016/j.jacc.2011.11.011
M3 - Article
C2 - 22322085
AN - SCOPUS:84856979700
SN - 0735-1097
VL - 59
SP - 681
EP - 687
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 7
ER -