Abstract 17584: Long-Term Outcome After Recommended Treatment for Cardiac Implantable Electronic Device Infection
Methods: All consecutive patients admitted to our institution for CIED infection between 2004 and 2008 were included. In all cases, a standardized multidisciplinary management approach was used, i.e., 1/removal of all hardware, if possible; 2/ prolonged adjunctive antimicrobial therapy in case of infective endocarditis (IE) or positive blood cultures; and 3/ implantation of a new device in another pocket site, if necessary, after antimicrobial therapy. Demographic and clinical data were recorded and follow-up data were collected prospectively during repeated outpatient consultations.
Results: A total of 197 patients (146 males) with a mean age of 71.0 ± 13.8 years were studied. Median follow-up was 25 months (range, 0–70 months). Clinical presentation was classified as pocket infection in 41% of cases and as frank or suspected IE in 26% and 33% respectively. Total or subtotal removal of the hardware was achieved in 99% of cases percutaneously in 93.4%. Overall mortality was 14.0 % at 1 year and 36.0% at 5 years. Infection-related mortality was 7%. The recurrence rate at 5 years was 1%. Multivariate analysis demonstrated 4 independent predictors of mortality, i.e., age at infection (OR=1.12, p=0.005), left ventricular ejection fraction < 0.35 (OR=4.04, p=0.029), negative culture of the removed hardware (OR=2.95, p=0.012), and platelet count < 100Giga/L (OR=3.86, p=0.03).
Conclusions: A standardized multidisciplinary management approach in accordance with current guidelines for CIED infection is associated with very low recurrence rate. However, long term infection-related and overall mortality remains high.
- © 2010 by American Heart Association, Inc.