• Eugene Athan, Vivian H Chu, Pierre Tattevin, Christine Selton-Suty, Phillip Jones, Christoph Naber, José M Miró, Salvador Ninot, Nuria Fernández-Hidalgo, Emanuele Durante-Mangoni, Denis Spelman, Bruno Hoen, Tatjana Lejko-Zupanc, Enrico Cecchi, Franck Thuny, Margaret M Hannan, Paul Pappas, Margaret Henry, Vance G Fowler, Anna Lisa Crowley, Andrew Wang, and ICE-PCS Investigators.
• Department of Infectious Diseases, Barwon Health, Geelong, Australia.
• JAMA. 2012 Apr 25;307(16):1727-35.

ContextInfection of implantable cardiac devices is an emerging disease with significant morbidity, mortality, and health care costs.ObjectivesTo describe the clinical characteristics and outcome of cardiac device infective endocarditis (CDIE) with attention to its health care association and to evaluate the association between device removal during index hospitalization and outcome.Design, Setting, And PatientsProspective cohort study using data from the International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS), conducted June 2000 through August 2006 in 61 centers in 28 countries. Patients were hospitalized adults with definite endocarditis as defined by modified Duke endocarditis criteria.Main Outcome MeasuresIn-hospital and 1-year mortality.ResultsCDIE was diagnosed in 177 (6.4% [95% CI, 5.5%-7.4%]) of a total cohort of 2760 patients with definite infective endocarditis. The clinical profile of CDIE included advanced patient age (median, 71.2 years [interquartile range, 59.8-77.6]); causation by staphylococci (62 [35.0% {95% CI, 28.0%-42.5%}] Staphylococcus aureus and 56 [31.6% {95% CI, 24.9%-39.0%}] coagulase-negative staphylococci); and a high prevalence of health care-associated infection (81 [45.8% {95% CI, 38.3%-53.4%}]). There was coexisting valve involvement in 66 (37.3% [95% CI, 30.2%-44.9%]) patients, predominantly tricuspid valve infection (43/177 [24.3%]), with associated higher mortality. In-hospital and 1-year mortality rates were 14.7% (26/177 [95% CI, 9.8%-20.8%]) and 23.2% (41/177 [95% CI, 17.2%-30.1%]), respectively. Proportional hazards regression analysis showed a survival benefit at 1 year for device removal during the initial hospitalization (28/141 patients [19.9%] who underwent device removal during the index hospitalization had died at 1 year, vs 13/34 [38.2%] who did not undergo device removal; hazard ratio, 0.42 [95% CI, 0.22-0.82]).ConclusionsAmong patients with CDIE, the rate of concomitant valve infection is high, as is mortality, particularly if there is valve involvement. Early device removal is associated with improved survival at 1 year.

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