Infective endocarditis and risk of death after cardiac implantable electronic device implantation: a nationwide cohort study

Abstract Background Cardiac implantable electronic device-related infective endocarditis (CIED-IE) comprises 10–57% of total CIED infections. Patients with definite CIED-IE who fulfill both major modified Duke criteria have not been well characterized. Methods Data from the Multicenter Electrophysiologic Device Infection Cohort, a prospective, multinational study of CIED infections were used to describe a subset of patients with CIED-IE who met both major Duke criteria for definite IE (bloodstream infection and intracardiac vegetations [VEG]). Results Of 433 patients with CIED infection, 144 (33.3%) had definite CIED-IE. The median age was 68 years and 77.1% were male. Twelve (8.3%) had past CIED infection. Seventy-seven patients (53.5%) had permanent pacemakers, 38 (26.4%) had implantable cardioverter defibrillators, and 29 (20.1%) had combination devices. The median time following the last device procedure was 550 days. CIED-IE was early in 60 patients (41.7%) and late in 84 (58.3%). Most patients presented with fever (77.8%) and sepsis (44.4%) with a median symptom duration of 7 days. On echocardiography, lead VEG was noted in 125 patients (86.8%) and valvular VEG in 54 patients (37.5%) with the tricuspid valve involved in 56.5%. On the basis of VEG location, there were 90 patients (62.5%) with isolated lead-associated IE (LAE), 19 patients (13.2%) with isolated valve-associated IE (VAE), and 35 patients (24.3%) with both (LVAE). All patients had positive blood cultures and 63/119 (52.9%) had positive lead cultures. The predominant organism in blood was Staphylococcus aureus (42.4%), followed by coagulase-negative staphylococci (20.1%). CIED removal occurred in 131 patients (91%). There were 25 deaths during the index hospitalization and 34 total deaths (24.3%) by 6 months. Mortality correlated with age >75 (P = 0.023) and sepsis on presentation (P = 0.052). Infecting organism, site of VEG, and device removal did not impact the risk of death. Conclusion Definite CIED-IE is relatively common. The majority of patients tend to have late-onset infection and often present with sepsis. S. aureus is the dominant organism causing definite CIED-IE. Isolated LAE occurs in 63% of patients. Older age and sepsis on admission are associated with higher mortality. Disclosures All authors: No reported disclosures.

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Infective endocarditis after cardiac implantable electronic device implantation: incidence and associated mortality

EP Europace ◽

10.1093/europace/euw419 ◽

2017 ◽

Vol 19 (6) ◽

pp. 885-886

Author(s):

Siva K. Mulpuru ◽

Paul A. Friedman

Keyword(s):

Infective Endocarditis ◽

Electronic Device ◽

Cardiac Implantable Electronic Device ◽

Device Implantation

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Postoperative Pain Control Following Cardiac Implantable Electronic Device Implantation

10.5772/intechopen.101517 ◽

2021 ◽

Author(s):

Peter Magnusson ◽

Jo Ann LeQuang ◽

Joseph V. Pergolizzi

Keyword(s):

Postoperative Pain ◽

Pain Control ◽

Electronic Device ◽

Perioperative Period ◽

Cardiac Implantable Electronic Device ◽

Opioid Use ◽

Acute Postoperative Pain ◽

Device Implantation ◽

Analgesic Regimen ◽

Short Course

Postoperative pain following cardiac implantable electronic device (CIED) surgery may not always be adequately treated. The postoperative pain trajectory occurs over several days following the procedure with tenderness and limited arm range of motion lasting for weeks after surgery. Pain control typically commences in the perioperative period while the patient is in the hospital and may continue after discharge; outpatients may be given a prescription and advice for their analgesic regimen. It is not unusual for CIED patients to be discharged a few hours after implantation. While opioids are known as an effective analgesic to manage acute postoperative pain, growing scrutiny on opioid use as well as their side effects and potential risks have limited their use. Opioids may be considered for appropriate patients for a short course of treatment of acute postoperative pain, but other analgesics may likewise be considered.

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Positive predictive value of infective endocarditis in the Danish National Patient Registry: a validation study

Epidemiology and Infection ◽

10.1017/s0950268818001401 ◽

2018 ◽

Vol 146 (15) ◽

pp. 1965-1967 ◽

Cited By ~ 9

Author(s):

Lauge Østergaard ◽

Kasper Adelborg ◽

Jens Sundbøll ◽

Lars Pedersen ◽

Emil Loldrup Fosbøl ◽

...

Keyword(s):

Infective Endocarditis ◽

Positive Predictive Value ◽

Predictive Value ◽

Medical Records ◽

Electronic Device ◽

Patient Registry ◽

Cardiac Implantable Electronic Device ◽

National Patient Registry ◽

Danish National Patient Registry ◽

National Patient

AbstractThe positive predictive value of an infective endocarditis diagnosis is approximately 80% in the Danish National Patient Registry. However, since infective endocarditis is a heterogeneous disease implying long-term intravenous treatment, we hypothesiszed that the positive predictive value varies by length of hospital stay. A total of 100 patients with first-time infective endocarditis in the Danish National Patient Registry were identified from January 2010 – December 2012 at the University hospital of Aarhus and regional hospitals of Herning and Randers. Medical records were reviewed. We calculated the positive predictive value according to admission length, and separately for patients with a cardiac implantable electronic device and a prosthetic heart valve using the Wilson score method. Among the 92 medical records available for review, the majority of the patients had admission length ⩾2 weeks. The positive predictive value increased with length of admission. In patients with admission length <2 weeks the positive predictive value was 65% while it was 90% for admission length ⩾2 weeks. The positive predictive value was 81% for patients with a cardiac implantable electronic device and 87% for patients with a prosthetic valve. The positive predictive value of the infective endocarditis diagnosis in the Danish National Patient Registry is high for patients with admission length ⩾2 weeks. Using this algorithm, the Danish National Patient Registry provides a valid source for identifying infective endocarditis for research.

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