Forty-Year Trends in Cardiac Implantable Electronic Device Infective Endocarditis

Marta Hernández-Meneses; Jaume Llopis; Elena Sandoval; Salvador Ninot; Manel Almela; Carlos Falces; Juan M Pericàs; Bárbara Vidal; Andrés Perissinotti; Francesc Marco; Carlos A Mestres; Carlos Paré; Cristina García de la María; Guillermo Cuervo; Eduard Quintana; José M Tolosana; Asunción Moreno; José M Miró; Hospital Clinic Infective Endocarditis Team Investigators

doi:10.1093/ofid/ofac547

Forty-Year Trends in Cardiac Implantable Electronic Device Infective Endocarditis

Open Forum Infect Dis. 2022 Oct 14;9(11):ofac547. doi: 10.1093/ofid/ofac547. eCollection 2022 Nov.

Authors

Marta Hernández-Meneses¹, Jaume Llopis², Elena Sandoval³, Salvador Ninot³, Manel Almela⁴, Carlos Falces⁵, Juan M Pericàs^{1

6}, Bárbara Vidal⁵, Andrés Perissinotti^{7

8}, Francesc Marco⁴, Carlos A Mestres³, Carlos Paré⁵, Cristina García de la María¹, Guillermo Cuervo¹, Eduard Quintana³, José M Tolosana⁵, Asunción Moreno¹, José M Miró^{1

9}; Hospital Clinic Infective Endocarditis Team Investigators

Affiliations

¹ Infectious Diseases Department, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
² Department of Genetics, Microbiology and Statistics, Faculty of Biology, University of Barcelona, Barcelona, Spain.
³ Cardiovascular Surgery Department, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain.
⁴ Department of Microbiology Hospital Clinic, ISGlobal, University of Barcelona, Barcelona, Spain.
⁵ Cardiology Department, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain.
⁶ Liver Unit, Internal Medicine Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Research, CIBERehd, Barcelona, Spain.
⁷ Department of Nuclear Medicine, Hospital Clinic, IDIBAPS, Barcelona, Spain.
⁸ Biomedical Research Networking Center of Bioengineering, Biomaterials and Nanomedicine, Barcelona, Spain.
⁹ Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.

Abstract

Background: Studies investigating cardiac implantable electronic device infective endocarditis (CIED-IE) epidemiological changes and prognosis over long periods of time are lacking.

Methods: Retrospective single cardiovascular surgery center cohort study of definite CIED-IE episodes between 1981-2020. A comparative analysis of two periods (1981-2000 vs 2001-2020) was conducted to analyze changes in epidemiology and outcome over time.

Results: One-hundred and thirty-eight CIED-IE episodes were diagnosed: 25 (18%) first period and 113 (82%) second. CIED-IE was 4.5 times more frequent in the second period, especially in implantable cardiac defibrillators. Age (63 [53-70] vs 71 [63-76] years, P < .01), comorbidities (CCI 3.0 [2-4] vs 4.5 [3-6], P > .01), nosocomial infections (4% vs 15.9%, P = .02) and transfers from other centers (8% vs 41.6%, P < .01) were significantly more frequent in the second period, as were methicillin-resistant coagulase-negative staphylococcal (MR-CoNS) (0% vs 13.3%, P < .01) and Enterococcus spp. (0% vs 5.3%, P = .01) infections, pulmonary embolism (0% vs 10.6%, P < .01) and heart failure (12% vs 28.3%, p < .01). Second period surgery rates were lower (96% vs 87.6%, P = .09), and there were no differences in in-hospital (20% vs 11.5%, P = .11) and one-year mortalities (24% vs 15%, P = .33), or relapses (8% vs 5.3%, P = 0.65). Multivariate analysis showed Charlson index (hazard ratios [95% confidence intervals]; 1.5 [1.16-1.94]) and septic shock (23.09 [4.57-116.67]) were associated with a worse prognosis, whereas device removal (0.11 [.02-.57]), transfers (0.13 [.02-0.95]), and second-period diagnosis (0.13 [.02-.71]) were associated with better one-year outcomes.

Conclusions: CIED-IE episodes increased more than four-fold during last 40 years. Despite CIED-IE involved an older population with more comorbidities, antibiotic-resistant MR-CoNS, and complex devices, one-year survival improved.

Keywords: 40 years; CIED infective endocarditis; device removal; epidemiology; prognosis.