Clinical Characteristics and Outcome of Infective Endocarditis Involving Implantable Cardiac Devices

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art_ATHAN_Clinical_Characteristics_and_Outcome_of_Infective_Endocarditis_Involving_2012.PDF (240.99 KB)
Citações na Scopus
238
Tipo de produção
article
Data de publicação
2012
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
AMER MEDICAL ASSOC
Autores
ATHAN, Eugene
CHU, Vivian H.
TATTEVIN, Pierre
SELTON-SUTY, Christine
JONES, Phillip
NABER, Christoph
MIRO, Jose M.
NINOT, Salvador
FERNANDEZ-HIDALGO, Nuria
DURANTE-MANGONI, Emanuele
Citação
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, v.307, n.16, p.1727-1735, 2012
Projetos de Pesquisa
Unidades Organizacionais
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Resumo
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
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URI
https://observatorio.fm.usp.br/handle/OPI/33302
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Coleções
Artigos e Materiais de Revistas Científicas - HC/InCor
Artigos e Materiais de Revistas Científicas - LIM/47