Forty-Year Trends in Cardiac Implantable Electronic Device Infective Endocarditis

Area of Science:

• Cardiology
• Infectious Diseases
• Medical Device Technology

Background:

• Long-term epidemiological and prognostic data on cardiac implantable electronic device infective endocarditis (CIED-IE) are scarce.
• Understanding trends in CIED-IE is crucial for managing device-related infections.

Purpose of the Study:

• To analyze the epidemiological changes and outcomes of CIED-IE over a 40-year period.
• To compare CIED-IE characteristics and prognosis between two distinct time intervals (1981-2000 vs. 2001-2020).

Main Methods:

• Retrospective cohort study of definite CIED-IE episodes from 1981 to 2020 at a single cardiovascular surgery center.
• Comparative analysis of patient demographics, comorbidities, causative pathogens, infection sources, and clinical outcomes between the periods 1981-2000 and 2001-2020.
• Multivariate analysis to identify factors associated with prognosis.

Main Results:

• CIED-IE episodes increased 4.5-fold in the second period (2001-2020), particularly with implantable cardiac defibrillators.
• Patients in the second period were older, had higher comorbidity scores (Charlson Comorbidity Index), and more nosocomial infections and transfers.
• Methicillin-resistant coagulase-negative staphylococcal (MR-CoNS) infections and pulmonary embolism became more frequent in the second period; however, in-hospital and one-year mortality rates did not differ significantly between the two periods.

Conclusions:

• CIED-IE incidence has significantly increased over the past four decades, involving a more complex patient population.
• Despite increased patient complexity and the rise of antibiotic-resistant pathogens, one-year survival for CIED-IE has shown improvement.
• Charlson index and septic shock are associated with worse prognosis, while device removal, patient transfers, and later diagnosis correlate with better one-year outcomes.