Forty-Year Trends in Cardiac Implantable Electronic Device Infective Endocarditis

Autor: Hernández-Meneses, Marta, Llopis Pérez, Jaime, Sandoval, Elena, Ninot, Salvador, Almela, M. (Manel), Falces, Carlos, Pericàs, Juan M., Vidal, Barbara, Perissinotti, Andrés, Marco Reverté, Francesc, Mestres, Carlos A., Pare i Bardera, J. Carles, García de la María, Cristina, Cuervo Requena, Guillermo, Quintana, Eduard, Tolosana, José M. (José María), Moreno Camacho, Ma. Asunción, Miró Meda, José M., Hospital Clinic Infective Endocarditis Team Investigators
Rok vydání: 2022
Předmět:
Zdroj: Open forum infectious diseases. 9(11)
ISSN: 2328-8957
Popis: 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.
Databáze: OpenAIRE
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