TY  - JOUR
T1  - CLinical characteristics and outcome of infective endocarditis involving implantable cardiac devices
AU  - Athan E, Chu VH, Tattevin P, et al
Y1  - 2012/04/25
N1  - 10.1001/jama.2012.497
JO  - JAMA
SP  - 1727
EP  - 1735
VL  - 307
IS  - 16
N2  - Context 
                  Infection of implantable cardiac devices is an emerging disease with significant morbidity, mortality, and health care costs.Objectives 
                  To 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 Patients 
                  Prospective 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 Measures 
                  In-hospital and 1-year mortality.Results 
                  CDIE 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]).Conclusions 
                  Among 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.
SN  - 0098-7484
M3  - doi: 10.1001/jama.2012.497
UR  - http://dx.doi.org/10.1001/jama.2012.497
ER  -