Right-sided infective endocarditis in cardiac device carriers: Clinical profile and prognosis.

Abstract

BACKGROUND AND OBJECTIVES:

Due to the widespread indications for device implants and the population aging, right-sided infective endocarditis (RSIE) epidemiology has dramatically changed, being nowadays, cardiac device carriers the main affected group. The aim of this work is to describe the epidemiology, clinical profile and outcomes of RSIE in cardiac device carriers.

PATIENTS AND METHODS:

We included definitive infective endocarditis episodes consecutively diagnosed in 3 tertiary centers from March 1995 to September 2014. A retrospective analysis of 85 variables, one-year follow up and univariate analysis of in-hospital mortality was conducted.

RESULTS:

Among 1,182 episodes, 100 cardiac device carriers presented with RSIE (8.5%). Mean age±SD was 67±14 years. Staphylococcus spp. were the main causative microorganisms (coagulase-negative 44%, aureus 31%) and 37% were methicillin-resistant. Cardiac devices were removed in 95% of patients. In-hospital mortality was 8% and one-year mortality was 4%. Univariate analysis demonstrated that renal failure at admission (OR 6.2; 95% CI 1.3-30.3), septic shock (OR 8.9; 95% CI 1.7-47.9) and persistent infection during clinical course (OR 19.4; 95% CI 3-125.7) increase in-hospital mortality while device removal is a protective factor (OR 0.08; 95% CI 0.02-0.39).

CONCLUSIONS:

RSIE have low in-hospital and one-year mortality. Coagulase-negative Staphylococci is responsible of almost half of the episodes and methicillin-resistant incidence is high. Device removal is mandatory since it decreases in-hospital mortality.

• Authors: Carlos Ortiz-Bautista, Javier López, Pablo Elpidio García-Granja, Isidre Vilacosta, Teresa Sevilla, Cristina Sarriá, Carmen Olmos, Carlos Ferrera, Carmen Sáez, Ana Puerto, José Alberto San Román
• Journal: Medicina clinica (Med Clin (Barc)) Vol. 149 Issue 11 Pg. 477-482 (Dec 07 2017) ISSN: 1578-8989 [Electronic] Spain
• Vernacular Title: Endocarditis infecciosa derecha en portadores de dispositivos cardiacos: perfil clínico y pronóstico.
• PMID: 28648588 (Publication Type: Journal Article)
• Copyright: Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

Topics

• Aged
• Aged, 80 and over
• Device Removal
• Endocarditis, Bacterial (diagnosis, etiology, mortality, surgery)
• Female
• Follow-Up Studies
• Heart Valve Prosthesis (adverse effects)
• Hospital Mortality
• Humans
• Male
• Middle Aged
• Prognosis
• Prosthesis-Related Infections (diagnosis, etiology, mortality, surgery)
• Retrospective Studies
• Spain (epidemiology)
• Staphylococcal Infections (diagnosis, etiology, mortality, surgery)