194 Cardiac device-related infective endocarditis: microbiological specificities and prognostic factors

Abstract

Mono-centric observation of microbiological specificities and prognostic factors in cardiac device-related infective endocarditis (CDIE). Review of 86 cases of certain CDIE gathered from 2000 to 2008, diagnosed on blood culture (77%) or lead tips culture (75%) and associated with evidence of vegetation on leads or on right heart endocardium. The infection was attributed to a coagulase-negative staphylococci (CNS) in 47% of the cohort; Staphylococcus aureus (SA) in 28%, the other gram-positive cocci in 13%, the gram-negative in 9% and gram-positive bacilli in 3%. CNS was associated with less left cardiac valves septic localisations (p=0,013) and with a better survival as compared to the other germs (p=0,013). The multivariate analysis looking for predictive factors for 1-year mortality conclude to a positive correlation with: – COPD (chronic obstructive pulmonary disease) (aOR, 1.23; 95% CI, 1.33 to 9.85; p=0.01), – Infections to a “non-CNS”; germ (aOR, 1.65; 95% CI, 1.50 to 18.22, p=0.009). Compared with an ‘historic’ reference series including 50 CDIE from 1992 to 1999, no significant microbiology evolution has been demonstrated (p=0.64) When compared prior to 2000 to following years, the patient's characteristics changed. The aging (p=0.01) and the severity of the cardiac disease (p<0.001) increased but long term mortality remained the same (aOR for 1992-1999 patients long term mortality, 1,061; 95% IC, 0.50 to 2.25; p=0.88). Microbiology and adjusted mortality of CDIE have not significantly changed since the 1990's. This study shows for the first time a significant prognostic difference according to germs involved, with a greater survival when CNS was incriminated.