Abstract 14610: Risks Factors of Mortality in Patients With Device Related Infection
Data on risk factors for mortality in patients with cardiac-device related infection (DRI) are limited and several questions remain for an optimal management of cardiac-device related infection. We evaluated the prognostic significance of key clinical variables in a large prospective cohort of patients with algorithms of DRI diagnosis and management.
Design: 594 consecutive patients were referred for DRI. Material removal was systematically proposed when DRI was retained or in case of local complications (impending erosion, erosion or local infection). The choice of percutaneous versus surgical extraction was based on vegetations' size. Antibiotics were administered intravenously for 2 weeks after lead removal, then orally for 4 weeks. DRI was confirmed based on positive bacteriological test from leads or infection resolution after material removal. Follow-up was 55 ± 31 months.
Results: 130 deaths occurred during follow-up with 43 pre-discharge deaths including 2 patients deceased before the procedure (2 sudden deaths) and 7 per-procedural deaths. The remaining 34 pre-discharge deaths were induced by: 14 septic shocks, 2 pneumonia, 3 heart failures, 1 pulmonary embolism, 8 multivisceral decompensation. 5 additional death had non infectious origin. Multivariate analysis shows that septic shock was associated with pre-discharge mortality and no extraction and reimplantation were inversely associated with mortality. During follow-up 9 additional deaths occurred in septic conditions. The risk factors for death related to infection are age,septic shock and vegetations. The results of blood cultures were associated with mortality only in univariate. Mean vegetation size was 23.8 mm in the surgical extraction group with 3 (4.4%) severe post-surgery complications and 5 (7.3%) deaths during hospitalization and 2 deaths in septic conditions during follow-up. 35 leads with vegetation> 20mm have been percutaneously extracted. 5 severe complications and 5 deaths occurred in this group (14.3%).
Conclusion: Systemic infection was the major factor of mortality. Vegetations were risk factors of infection related-mortality. Percutaneous extraction of leads with large vegetation is associated with mortality and severe complications.
- © 2011 by American Heart Association, Inc.