1111. Cardiac-electronic device extraction in patients with Infective Endocarditis secondary to Bacteremia
Session: Poster Abstract Session: Infections of Cardiovascular Devices
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Cardiac-electronic device infection is the leading cause of extraction. In cases of cardiac-device infective endocarditis (CDIE) the presenting signs might be ambiguous, such as bacteremia or pocket infection. Our goal was to determine the management and outcomes of CDIE in patients with initial diagnosis of bacteremia.

Methods: We retrospectively reviewed all patients who underwent cardiac device extraction and initial diagnosis of bacteremia referred to our institution for device removal between January 2004 and December 2009. Clinical protocols were used including preoperative transesophageal echocardiogram (TEE), blood cultures, intraoperative exudate, lead tip cultures, and laser-assisted removal. Bacteremia and CDIE were defined using microbiological and clinical criteria. Subjects were reclassified as to a final diagnosis by an infectious disease physician, based on findings during echocardiography, device removal, and culture data. Descriptive and statistical analyses were performed.

Results: There were 81 subjects (54 males, 27 females mean age 72.1±11.2, range 38-89) with cardiac devices who presented with signs and finding suggesting bacteremia who had subsequent culture and echocardiography data available. All patients underwent successful complete device removal (36 pacemakers, 30 implantable cardiac-defibillators and 15 biventricular-ICDs) including 195 leads. Fifty-seven (70.4%) patients had a device-related infective endocarditis. Thirty-seven (45.7%) blood cultures were positive for Methicillin-resistant Staphylococcus aureus (MRSA) followed by Methicillin-resistant Staphylococcus epidermidis (15,18.5%), Methicillin sensitive Staphylococcus aureus (7,8.64%), Methicillin sensitive Staphylococcus epidermidis (6,7.4%), Enterococcus faecalis (3,3.7%), Proteus mirabilis (2,2.5%), Pseudomona aeuruginosa (2,2.5%), and Candida parapsilosis(1,1.2%). TEE showed 48(59.2%) intracardiac vegetations attached to the lead. Index hospitalization mortality was 11 (13.6%) patients.

Conclusion: Bacteremia is a serious complication of cardiac implantable electronic device infection that may lead to endocarditis. System extraction results in a low perioperative mortality.


Subject Category: J. Clinical practice issues

Roger Carrillo, MD, Cardiothoracic Surgery, University of Miami Hospital Miller School of Medicine, Miami, FL and Juan D. Garisto, MD, University of Miami Hospital, Miami, FL

Disclosures:

R. Carrillo, Spectranetics: Speaker's Bureau, Speaker honorarium

J. D. Garisto, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.