Clinical Characteristics and Outcome of Infective Endocarditis Involving Implantable Cardiac Devices

Varování

Publikace nespadá pod Lékařskou fakultu, ale pod Středoevropský technologický institut. Oficiální stránka publikace je na webu muni.cz.

Autoři	ATHAN Eugene FREIBERGER Tomáš CHU Vivian H POL Jiří TATTEVIN Pierre MALIŠOVÁ Barbora SELTON-SUTY Christine JONES Phillip NABER Christoph MIRO Jose M NINOT Salvador FERNANDEZ-HIDALGO Nuria DURANTE-MANGONI Emanuele SPELMAN Denis HOEN Bruno LEJKO-ZUPANC Tatjana CECCHI Enrico THUNY Franck HANNAN Margaret M PAPPAS Paul HENRY Margaret FOWLER Vance G Jr CROWLEY Anna Lisa WANG Andrew
Rok publikování	2012
Druh	Článek v odborném periodiku
Časopis / Zdroj	JAMA-Journal of the American Medical Association
Fakulta / Pracoviště MU	Středoevropský technologický institut
Citace
www	http://jama.jamanetwork.com/article.aspx?articleid=1148195
Obor	Imunologie
Klíčová slova	CARDIOVERTER-DEFIBRILLATOR INFECTION; PERMANENT PACEMAKER; VALVE ENDOCARDITIS; RISK-FACTORS; MANAGEMENT; DIAGNOSIS; MORTALITY; PROGRESS
Popis	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. JAMA. 2012;307(16):1727-1735