Related Infective Endocarditis Research Articles

Cost-effectiveness of drug consumption rooms in France: a modelling study

BackgroundPeople who inject drugs (PWID) experience many health problems which result in a heavy economic and public health burden. To tackle this issue, France opened two drug consumption rooms (DCRs) in Paris and Strasbourg in 2016. This study assessed their long-term health benefits, costs and cost-effectiveness.MethodsWe developed a model to simulate two fictive cohorts for each city (n=2,997 in Paris and n=2,971 in Strasbourg) i) PWID attending a DCR over the period 2016-2026, ii) PWID attending no DCR. The model accounted for HIV and HCV infections, skin abscesses and related infective endocarditis, drug overdoses and emergency department visits. We estimated the number of health events and associated costs over 2016-2026, the lifetime number of quality-adjusted life-years (QALYs) and costs, and the incremental cost-effectiveness ratio (ICER).ResultsThe numbers of abscesses and associated infective endocarditis, drug overdoses, and emergency department visits decreased significantly in PWID attending DCRs (-77%, -69%, and -65%, respectively) but the impact on HIV and HCV infections was modest (-11% and -6%, respectively). This resulted in savings of €6.6 (Paris) and €5.8 (Strasbourg) millions of medical costs. The ICER of DRCs was €30,600/QALY (Paris) and €9,200/QALY (Strasbourg). In scenario analysis where drug consumption spaces are implemented inside existing harm reduction structures, these ICERs decreased to €21,400/QALY and €2,500/QALY, respectively.ConclusionsOur findings show that DCRs are highly effective and efficient to prevent harms in PWID in France, and advocate extending this intervention to other cities by adding drug consumption spaces inside existing harm reduction centers.

Abstract 16204: Scaling Hearts: Exploring the Link Between Psoriasis and Infective Endocarditis in Pacemaker Patients

Introduction: Device related infective endocarditis (IE) is associated with high morbidity and mortality resulting in a growing emphasis on identifying and managing comorbidities that increase the risk of IE in these patients. Psoriasis, a chronic inflammatory skin disorder with multifactorial etiology, is increasingly being identified as having multiple cardiovascular manifestations. However, little is known about the impact of psoriasis on IE risk in patients with permanent pacemaker (PPM). Hypothesis: Psoriasis patients with PPM have an increased risk of developing IE. Methods: Patients with a history of PPM implantation were sampled from the National Inpatient Sample Database (2016 - 2018). Comorbidities were identified using ICD-10 codes. Individuals with age < 18, history of endocarditis, immunosuppression, central line associated infections, intravenous drug use, and implantable cardiac defibrillators were excluded. Patients were stratified into two groups based on the presence of psoriasis. A univariate analysis followed by a multivariate analysis adjusting for age, gender valvular disease, dental infections, coronary artery disease, and sixteen other comorbidities was performed. Furthermore, 1:10000 propensity score matching was performed between the psoriasis and non-psoriasis groups and rates of IE were calculated. Results: Out of the 437,728 patients included in the study, 45 (4.4%) had psoriasis. Psoriasis patients were older and had more coronary artery disease. Psoriasis patients had significantly higher rates of endocarditis (4.4% vs 0.6%; p<0.001). On multivariate analysis, psoriasis was linked to a 7.2-fold higher IE risk compared to patients without psoriasis (OR: 7.2 [1.7-30.2]; p=0.007). Post-match analysis showed similar results with 8.3-fold higher rates of IE in psoriasis patients (OR: 8.3 [2.0-34.4]; p<0.001). Conclusions: Psoriasis was independently associated with elevated risk of IE in patients with PPM. The chronic inflammatory state associated with psoriasis likely contributed to this risk. Further large-scale studies are required to corroborate these findings as this will have implications on consideration of IE prophylaxis for these patients.

Transcatheter vacuum aspiration of valvular and lead related infective endocarditis

BackgroundTranscatheter aspiration is utilized for removal of thrombi and vegetations in inoperable patients and high-risk surgical candidates where medical therapy alone is unlikely to achieve desired outcome. A number of case reports and series have been published since the introduction of AngioVac system (AngioDynamics Inc., Latham, NY) in 2012 where this technology was used in the treatment of endocarditis. However, there is a lack of consolidated data reporting on patient selection, safety and outcomes. MethodsPubMed and Google Scholar databases were queried for publications reporting cases where transcatheter aspiration was used for endocarditis vegetation debulking or removal. Data on patient characteristics, outcomes and complications from select reports were extracted and systematically reviewed. ResultsData from 11 publications with 232 patients were included in the final analyses. Of these, 124 had lead vegetation aspiration, 105 had valvular vegetation aspiration, and 3 had both lead as well as valvular vegetation aspiration. Among the 105 valvular endocarditis cases, 102 (97 %) patients had right sided vegetation removal. Patients with valvular endocarditis were younger (mean age 35 years) vs. patients with lead vegetations (mean age 66 years). Among the valvular endocarditis cases, there was a 50–85 % reduction in vegetation size, 14 % had worsening valvular regurgitation, 8 % had persistent bacteremia and 37 % required blood transfusion. Surgical valve repair or replacement was subsequently performed in 3 % and in-hospital mortality was 11 %. Among patients with lead infection, procedural success rate was reported at 86 %, 2 % had vascular complications and in-hospital mortality was 6 %. Persistent bacteremia, renal failure requiring hemodialysis, and clinically significant pulmonary embolism occurred in about 1 % each. ConclusionsTranscatheter aspiration of vegetations in infective endocarditis has acceptable success rates in vegetation debulking as well as rates of morbidity or mortality. Large prospective multi-center studies are warranted to determine predictors of complications, thus helping identify suitable patients.

Temporary trends of cardiac device related infective endocarditis in a tertiary referral center between 2006 and 2022

Abstract Funding Acknowledgements Type of funding sources: None. Background Infective endocarditis (IE) is a rare, but life-threatening complication of cardiac device implantation. Despite recent preventive strategies and advances in antimicrobial and surgical treatment, morbidity and mortality rates are still high. Aims The objective of our study was to assess the epidemiological characteristics, temporal trends and mortality rates of cardiac device related IE (CDRIE) in our high-volume, tertiary referral center. Methods retrospective data collection was performed between January 1, 2006 and March 31, 2022. Median follow-up was 3.8 yrs (IQR: 0.6 – 9.2 yrs). Patients admitted between 2006 and 2013 (group 1) and between 2014 and 2022 (group 2) were compared to assess temporal trends. Thirty-day, 6-month and 1-year mortality rates were estimated. Results During the observed 17 years 82 patients were admitted with CDRIE (61 males [74%]), mean age: 57.3 ±18 yrs; 6 VVI, 7 VDD, 17 VVI-ICD, 24 DDD, 10 DDD-ICD and 18 CRT devices [4 CRT-P, 14 CRT-D]); median time since first implantation was 3.8 yrs [IQR: 1.1 – 6.6 yrs]). Staphylococci were the most prevalent infective agents (62%), S. aureus (SA) infection was found in 37 cases (out of whom 13 were MRSA [16%]), coagulase negative Staphylococcus in 14 cases (17%), Enterococcus faecalis in 9 cases (11%), streptococci in 4 cases (5%), blood culture was negative in 13 cases (15%), and in 5 cases other pathogens were the underlying microorganism. Patients in Group 1 (n=42) did not differ from patients in Group 2 (n=40) in terms of age, male gender or ejection fraction. Patients in Group 2 had higher CRP level at admission (42,9 [IQR:34-55] mmol/l vs 90 [IQR:25-60] mmol/l, p=0.02). ICD lead (29% vs 67%, p<0.001) and E. faecalis infection (2% vs 20%, p=0.03) and percutan extraction (55% vs 75%, p=0.05) were more prevalent in Group 2. The 30-day and 6-month mortality rates were worse in Group 2 than in Group 1 (2% vs 17.5% p=0.03; and 16% vs 35% p=0.04 resp.) while the 1-year mortality did not differ (24% vs 40%). The all-cause mortality was 10% at 30 days, 26% at 6 month and 32% at 1 year. Univariate regression showed that age (HR: 1.03 [1.01-1.07] p<0.05), ejection fraction (HR: 0.96 [0.93-0.98] p<0.005), ICD lead (HR: 4.89 [1.82-14.40] p<0.005) and the time since first implantation (HR: 0.88 [0.77-0.98] p<0.05) were the predictors of 1-year mortality. However, in Cox multiple regression model only age (HR: 1.05 [1.004-1.1] p<0.05) and ICD lead (HR: 1.16 [1.16-17.38] p<0.05) remains independent predictors of outcome at 1 year. Conclusions In the past 17 years the most prevalent underlying microorganism were staphylococcal species, although Enterococcus faecalis infection increased over time. Patients with CDRIE had poor prognosis, every third patient died at 1 year after diagnosis. The short-term prognosis is even worse in the past few years than before, which may be a negative consequence of limited accessibility of healthcare due to COVID 19 pandemic.

P483 IMPACT OF AN ENDOCARDITIS TEAM ON PROGNOSIS: PRELIMINARY RESULTS

Abstract Infective endocarditis (IE) is a life–threatening microbial infection with high mortality rate (6–50% in–hospital and 19–82% at 5–years)1.Guidelines for management of infective endocarditis underline the importance of multidisciplinary approach with an Endocarditis Team (ET) for the complexity of disease and for prognosis which depends on patients’ characteristics, microorganisms involved and local or systemic complications.ET includes specialists that define multimodality imaging approach to confirm diagnosis and to exclude local or systemic complications, discuss timing of antibiotic therapy, indication and timing of surgical treatments and follow–up. This study was a retrospective analysis based on a population of 86 patients from Infermi Hospital, Rimini, who received a diagnosis of IE from 2019 to 2021 thanks to a multidisciplinary approach. Among 86 patients, 76 (88,4%) had early–diagnosed IE and 10 (11,3%) had late–diagnosed IE.Early–diagnoses IE was defined when diagnoses occurred within 30 days from first symptoms.The aim of this study was to assess the impact of ET on timeliness of diagnosis and prognosis.Comparing the two groups, in the early–diagnosed IE we found higher rate of risk factors for endocarditis and systemic embolisation (27,6% vs. 20%), with Staphylococcus and Streptococcus as the most frequent causative pathogens (43,4% and 31,5%).More frequently the late–diagnosed IE group had mechanical prosthetic valves (20% vs 7,8%) with a higher rate of cardiac surgery (80% vs 35,5%), cardiac valves complications such as abscesses, perforations and pseudo–aneurysms (20% vs 18,4%) and a higher rate of intra–hospital mortality (40% vs 18,4%). Streptococcus and Enterococcus were most involved in the late–diagnosed group.Several trials demonstrated that presence of ET reduces 1–year mortality from 18.5% to 8.2% 2 and in–hospital mortality from 28% to 13% 3. Our preliminary study confirms the importance of ET application to improve early diagnosis (88.4%) and to reduce mortality. Bibliography:1.Kouijzer et al., Native valve, prosthetic valve, and cardiac device–related infective endocarditis: A review and update on current innovative diagnostic and therapeutic strategies(2022). 2.Botelho–Nevers et al. Dramatic reduction in infective endocarditis–related mortality with a management–based approach(2009). 3.Chirillo,F.et al. Impact of a multidisciplinary management strategy on the outcome of patients with native valve infective endocarditis(2013).

P254 "GHOST" IN RIGHT VENTRICLE: AN ECHOCARDIOGRAPHIC FINDING AFTER TRANSVENOUS LEAD EXTRACTION

Abstract Introduction Prolonged antibiotic therapy and complete hardware removal are recommended in definite cardiac device–related infective endocarditis (CDRIE), as well as in presumably isolated pocket infection, in class I. A tubular mobile mass, known as ghost, that previously surrounded the lead can be detected by ultrasounds, in 8–14% of patients undergoing transvenous lead extraction (TLE). Case presentation: A 72–year–old man with ischemic cardiomyopathy is referred to our center due to a persistent fever. His medical history shows a previous extraction of CRT–D for infection of the left infraclavicular pocket, with a new implantation of CRT–P on the right side of the chest, in consideration of the recovery of the ejection fraction. At the entrance to the ward he has fever and inflammation‘s signs of the pocket of the generator, with positive blood cultures for Staphylococcus Aureus Methicillin resistant. A transesophageal echocardiography (TEE) excludes vegetations of valve systems and electrocatheters. Therefore, the patient begins antibiotic therapy and undergoes full extraction of the device (generator and leads). A post–operative transthoracic echocardiography shows the presence of a linear image of 2.5 cm in the right ventricle, seen as remnants of scar tissue surrounding the lead. ECG monitoring detects phases of BAV 2:1. Considering the high risk of infectious disease, a pacemaker leadless implantation is indicated. The surgery is postposted at the end of the 4 weeks of antibiotic therapy, checking blood cultures before implantation to reduce the residual infectious risk. Discussion The persistence of fibrous residues after TLE has been variously described in recent years, but it is unclear whether these are predictors of increased mortality. The current guidelines on the therapeutic management of patients with infectious endocarditis and pacemaker dependency do not indicated the timing of reimplantation, in a potentially infectious ghost setting. Clinical co–morbidities play a crucial role in the prognosis of patients, especially when combined with systemic infections. Conclusion An echocardiographic follow–up is recommended to detect ghost disappearance in patients undergoing explant due to a related device infection. In fact, a rapid fibrin dissolution process usually takes place when the thrombogenic stimulus is removed.

Outcomes of Patients Hospitalized With Cardiovascular Implantable Electronic Device-Related Infective Endocarditis, Prosthetic Valve Endocarditis, and Native Valve Endocarditis: A Nationwide Study, 2003 to 2017.

BackgroundMost published reports describing outcomes of patients with cardiovascular implantable electronic device–related infective endocarditis (CIED‐IE) are single‐center studies with small patient sample sizes. The goal of this study was to utilize population‐based data to assess trends in CIED‐IE hospitalization and to compare outcomes between patients hospitalized with CIED‐IE, prosthetic valve endocarditis (PVE), and native valve endocarditis (NVE).Methods and ResultsA query of the National (Nationwide) Inpatient Sample (NIS) database between 2003 and 2017 identified 646 325 patients hospitalized with infective endocarditis in the United States of whom 585 974 (90%) had NVE, 27 257 (4.2%) had CIED‐IE, and 26 111 (4%) had PVE.There was a 509% increase in CIED‐IE hospitalizations in the United States from 2003 to 2017 (P trend<0.001). In‐hospital mortality and length of stay associated with CIED‐IE decreased during the study period from 15% and 20 days in 2003 to 9.7% and 19 days in 2017 (P trend=0.032 and 0.018, respectively). The in‐hospital mortality rate was lower in patients hospitalized with CIED‐IE (9.2%) than in patients with PVE (12%) and NVE (12%). Length of stay was longest in the CIED‐IE group (17 compared with 14 days for both NVE and PVE). Hospital costs were highest for the CIED‐IE group ($56 000 compared with $37 000 in NVE and $45 000 in PVE).ConclusionsDespite the fact that the number of comorbidities per patient with CIED‐IE increased during the study period, mortality rate and hospital length of stay decreased. The mortality rate was significantly lower for patients with CIED‐IE than for patients with NVE and PVE. Patients with CIED‐IE had the longest lengths of stay and highest hospital costs.

Premier cas d'endocardite infectieuse sur valve aortique prosthétique dû à Prevotella Intermedia

IntroductionPrevotella species (i. e. P. intermedia, P. nigrescens, P. pallens, P. oris) are usually responsible for abscesses of head and neck spaces after dental procedures. P. intermedia – related infective endocarditis has never been reported. Case ReportA 22-year-old man, with a history of aortic valve replacement 6 years ago, presented with fever and persistent retrosternal chest pain. An empirical antibiotic therapy was started on (cefotaxime, 2gx3 – gentamicin, 5mg/kilo). Five blood cultures were positive at Prevotella Intermedia. Metronidazole was introduced (500mg X 3 by day).The oro-pharyngeal spaces were normal. The evolution was marked by a hypotension, a third degree atrio-ventricular block, and a rapidly growing aortic root abscess complicated this case of Prevotella Intermedia infective endocarditis (IE). Aortic valve redux surgery was performed at day 5 of admission. Post-operative course was unremarkable. ConclusionThis first reported case of Prevotella Intermedia IE presented suggestive features of anaerobic IE as the patient developed both aortic-ring abscess, third degree atrio-ventricular block and hypotension.

Clinical profile and one-year outcomes of patients with mural infective endocarditis: – A tertiary care centre study based on data from a seven-year registry

BackgroundInfective endocarditis patients present very rarely with vegetations on the mural endocardium. Only very few studies are available comparing Mural infective endocarditis with commoner valvular or device related infective endocarditis. AimTo analyse the clinical features, microbiological profile and clinical course of mural endocarditis in comparison to valvular endocarditis. MethodsThis was a retrospective analysis of data from a registry of infective endocarditis. Patients enrolled between April 2012 and April 2019 were included. Patients who were reported to have vegetations on the mural endocardial surface were taken as a group and compared with rest of the patients. Clinical profile, laboratory parameters including culture and outcomes were compared between the two groups. ResultsOut of 278 patients in the study, 15 (5.38%) had vegetations on the mural endocardium. Of them, only 4 patients had structural heart diseases. All the patients with mural endocarditis were NYHA class II or below at presentation. Ventricles were the commonest sites of vegetations. Inflammatory markers like ESR and CRP were low in mural endocarditis compared to rest. Culture positivity was high in mural endocarditis and Staphylococcus Aureus was the commonest organism. Mural endocarditis patients had similar in hospital mortality to rest of the patients. Cardiac complications were not reported in mural endocarditis, but they had similar incidence of embolic complications including neurological events. ConclusionMural endocarditis is a rare clinical entity with similar morbidity and mortality to that of endocarditis with valvular vegetation.

Transcatheter aortic valve replacement associated infective endocarditis case series: broadening the criteria for diagnosis is the need of the hour

BackgroundTranscatheter valve replacement (TAVR) is an important therapeutic intervention for patients with aortic valve stenosis. As TAVR has become available to a broader population, there has been an increase in the number of less common, yet potentially catastrophic, complications. TAVR related infective endocarditis (TAVR-IE) is a rare, but potentially fatal, complication.Case seriesWe present here two patients that we encountered for TAVR associated infective endocarditis. Our first patient presented 5 weeks after his TAVR. His initial presentation was consistent with signs of sepsis. The patient then developed Mobitz type I block during hospital course. His TEE was negative for features of infective endocarditis. Due to high suspicion, patient was taken for surgical exploration and was found to have multiple foci of vegetation adhered to the stent frame. Our second patient presented with new onset pulmonary edema, worsening heart failure and systemic inflammatory response. A TEE was done for persistent MSSA bacteremia which showed stable prosthetic valve function with no signs of infective endocarditis. Patient was discharged with a prolonged course of intravenous antibiotics. Patient was re-admitted for worsening sepsis and blood cultures were positive for MSSA. Patient was taken for surgical exploration of his prosthetic aortic valve which showed purulent aortic root abscess.ConclusionThrough these cases, we aim to raise awareness on TAVR-IE. Due to the atypical clinical presentation, the modified Duke criteria may not be sufficient to diagnose TAVR-IE. Transesophageal echocardiogram in TAVR-IE may be negative or indeterminate. Prosthetic valve shadow may obscure smaller vegetations and/or smaller abscesses. A negative transesophageal echocardiogram should not rule out TAVR-IE and further diagnostic imaging modalities should be considered. PET/CT after administration of 18F-FDG (fluorodeoxyglucose) is a useful diagnostic tool in the diagnosis of infective endocarditis where TEE has been negative or inconclusive. Multi-modal imaging, in addition to the modified Duke criteria, can facilitate early diagnosis and improved mortality outcomes.

Abstract 14280: Trends and Association of Payer Status With Outcomes in Injection Drug Use Related Infective Endocarditis, From National Inpatient Sample (2002-2017)

Introduction: Infective endocarditis (IE) associated with intravenous drug abuse (IDU) is rising in incidence in the United States. Few studies exist on the association of IDU in IE with primary payer and socio-economic status. Hypothesis: Type of primary insurance payer and socio-economic status in patients with IDU related IE may strongly correlate with inpatient morbidity and mortality. Methods: We used the United States National Inpatient Sample (NIS) data from the year 2002 to 2017. International Classification of Diseases (ICD)-9 and ICD-10 codes were used to identify all hospitalizations with IDU-IE above the age of 17 years. Pearson chi-square test and Mann Whitney U test were used for statistical testing. Multivariate logistic regression analysis was done for adjusted cohort. Results: Primary payers of 78,211 weighted admissions of patients with IDU-IE were identified. Most of the patients were Medicare/Medicaid (67.6%), followed by private insurance(13%) and self-pay(19.3%). Patients under Medicaid/Medicare were older (37yrs. [interquartile range (IQR), 29-47) as compared to private pay (34yrs. [IQR, 25-47]) and self-pay(34 yrs. [IQR,28-43]). Comorbid conditions like liver disease, viral hepatitis, peripheral vascular disease (PVD), renal disease, psychosis, depression, and AIDs were more common in Medicare/Medicaid population (Figure). Patients under private insurance had a higher median income. Patients under Medicare/Medicaid had higher adjusted mortality (1.162, [confidence interval (CI), 1.082-1.248]) as compared to private insurance (0.852, [CI, 0.764-0.95]) but no difference in adjusted mortality as compared to self-pay (OR, 0.927, [CI, 0.855-1.006]). Conclusions: The medical coverage of patients with IDU-IE over the years has increased, however, mortality is still higher in patients with Medicare/Medicaid as compared to private insurance, the reason behind this needs further exploration.

Impact of delayed device re-implantation on outcomes of patients with cardiovascular implantable electronic device related infective endocarditis.

Optimal timing of cardiovascular implantable electronic device (CIED) re-implantation following device removal due to infection is undefined. Multinational guidelines reflect this and include no specific recommendation for this timing, while others have recommended waiting at least 14 days in cases of CIED related infective endocarditis (CIED-IE). The current work seeks to clarify this issue. We retrospectively reviewed institutional data at Mayo Clinic, Minnesota of patients aged ≥ 18 years who developed CIED-IE from January 1, 1991 to February 1, 2016. CIED-IE was defined as echocardiogram reported device lead or valvular vegetation. Regression analyses were used to relate the risk of clinical outcomes to the interval between CIED removal and re-implantation and the location of vegetations. A total of 109 patients met study inclusion criteria. A majority (68.8%) of patients were men and the median age was 68.0 years. Transoesophageal echocardiogram (TEE) was performed in 95.4% of patients, with valve vegetations detected in 33.9% (n=37). Survival analysis comparing patients in whom device re-implantation was<14 days vs. ≥14 days, and further categorized by those with and without valve vegetation, showed a significant difference (P=0.028); patients with valve vegetation and reimplantation interval<14 days had the lowest (58.7%) 12-month survival. When adjusted for valve vegetation, longer time interval for reimplantation trended toward increased hospital length of stay (P=0.079). Our findings suggest that the recommended 14-day delay between CIED extraction and re-implantation in CIED-IE patients is associated with a survival benefit, but longer length of hospital stay following re-implantation.

Cardiac device-related infective endocarditis in the Czech Republic: Prospective data from the ESC EORP EURO-ENDO registry.

Understanding cardiac electronic device infective endocarditis epidemiology is essential for the management of this serious complication. Only monocentric and limited data have been published regarding patients in the Czech republic so far. The aim of this study was to describe the current profile, microbiology and clinical characteristics of this population. National data from the prospective ESC-EORP EURO-ENDO registry were collected. 57 consecutive patients with a diagnosis of cardiac device-related infective endocarditis (CDRIE) from 11 Czech centres were included. Staphylococcus spp. was responsible for 43.9% of isolates, whereas Culture negative endocarditis was documented in 26.3% episodes. The most frequent complications under therapy were acute renal failure (17.5%), septic shock and heart failure (both 10.5%). Extraction of device was performed in 75.4% of all patients, and the 1-year mortality was 22.5%. The high proportion of culture-negative endocarditis is alarming and warrants further investigation. Cardiac device related infective endocarditis is a serious complication with a high 1-year mortality in a highly polymorbid spectrum of patients.

Comparing right- and left sided injection-drug related infective endocarditis

The aim of the study was to compare background characteristics, microbiology and outcome of patients with right-sided and left-sided intravenous drug use (IDU) associated infective endocarditis (IE). A nationwide retrospective study using the Swedish Registry on Infective Endocarditis between 2008 and 2019 was conducted. A total of 586 people with IDU-IE were identified and divided into left-sided (n = 204) and right-sided (n = 382) IE. Descriptive statistics, Cox-regression and Kaplan–Meier survival estimates were used. The mean age of patients in the left-sided group was 46 years compared to 35 years in the right-sided group, p < 0.001. Left-sided IE had a higher proportion of females. Staphylococcus aureus was the causative pathogen in 48% of cases in the left-sided group compared to 88% in the right-sided group. Unadjusted and adjusted long-term survival was better in right-sided IE compared to left-sided IE. Independent predictors of long-term mortality were increasing age, end-stage renal disease, nosocomial infection, brain emboli and left-sided IE. Left-sided IE was common in people with IDU but the proportion of females with left-sided IE was low. S. aureus was twice as common in right-sided IE compared to left-sided IE, and the long-term prognosis of right sided IDU-associated IE was better compared to left-sided IE despite the fact that few were operated.

Cardiac Electronic Devices: Future Directions and Challenges.

Cardiovascular implantable electronic devices (CIEDs) are essential management options for patients with brady- and tachyarrhythmias or heart failure with concomitant optimal pharmacotherapy. Despite increasing technological advances, there are still gaps in the management of CIED patients, eg, the growing number of lead- and pocket-related long-term complications, including cardiac device–related infective endocarditis, requires the greatest care. Likewise, patients with CIEDs should be monitored remotely as a part of a comprehensive, holistic management approach. In addition, novel technologies used in smartwatches may be a convenient tool for long-term atrial fibrillation (AF) screening, especially in high-risk populations. Early detection of AF may reduce the risk of stroke and other AF-related complications. The objective of this review article was to provide an overview of novel technologies in cardiac rhythm–management devices and future challenges related to CIEDs.

The epidemiology of infective endocarditis with focus on non-device related right-sided infective endocarditis: A retrospective register-based study in the region of Southern Denmark

AimsNon-device related right-sided infective endocarditis (ND-RSIE) is not well characterized. We aimed to characterize patients with infective endocarditis (IE) with emphasis on the epidemiology, clinical characteristics and complications of ND-RSIE. MethodsIn this population-based cohort study, we identified patients with IE using ICD-10 codes from the Danish National Hospital Register in the Region of Southern Denmark between January 2007 and May 2017. Hospital records were reviewed, and characteristics and outcomes recorded. ResultsWe included 1243 confirmed IE episodes of which 82% were left-sided IE, 11% were cardiac device right sided infective endocarditis (RSIE) and 7% were ND-RSIE. Patients with ND-RSIE were considerably younger, had less comorbidity and had a lower 30-day mortality (6%) compared with patients with device RSIE (24%) and left-sided IE (26%) (p<0.01). ND-RSIE was associated with underlying heart disease, involvement of the tricuspid valve (57%), Staphylococcus species (53%) and complications (61%). Forty percent of ND-RSIE occurred among people who inject drugs (PWID) for whom significant differences were observed compared with non-PWID with regards to tricuspid valve involvement (96% vs. 32%), causative microorganisms (Staphylococcus aureus 79% vs. 27%), complications (86% vs. 45%), recurrence (29% vs. 11%) and 30-day mortality (0% vs. 7%). ConclusionND-RSIE is relatively rare and differs with regards to epidemiology, clinical characteristics and complications compared with left-sided IE and cardiac device RSIE, but has a favourable prognosis. Forty percent of ND-RSIE occurs among PWID, which is associated with frequent complications but a very low mortality.

P835 Mitral valve abscess complicating infective endocarditis

Abstract Funding Acknowledgements n/a Background Health care associated infective endocarditis (HAIE) accounted for u to 30% of infective endocarditis (IE) cases, it tends to affect patients with a poor clinical condition and represents a considerable in-hospital mortality. Case A 75-years old gentleman with end-stage renal failure secondary to polycystic kidney disease had commenced hemodialysis via a tunneled hemodialysis catheter 3 months ago, presented for pre-operative evaluation before vascular surgery for acute left lower limb ischemia, patient gave history of fever for the past month partially responding to antipyretics along with recent ischemic cerebrovascular stroke with no residual neurological deficits. On examination he had a blood pressure of 110/70 mmHg, a heart rate of 100 bpm, a temperature of 38oC, and a harsh pansystolic murmur over the apex. Laboratory results revealed leukocytosis elevated CRP and blood cultures were positive for staphylococcus aureus. Electrocardiography showed sinus tachycardia. Methods and Results 2D-Trans-Thoracic Echocardiography (TTE) revealed the presence of echogenic rounded mobile mass measured 2x2 cm attached to the atrial surface of the posterior mitral valve leaflet. There was a severe mitral valve regurgitation and the regurgitant jet was directed anteriorly swirling around the mass. The left ventricle dimensions and function were normal. 2D-Trans-esophageal Echocardiography(TEE) was done for better visualization of the mass and it"s attachment. The mass was overlying the atrial surface of the posterior leaflet middle P2 scallop with a small echo-lucent cavity (abscess formation) in the leaflet in addition to another smaller mass at the atrial surface of the anterior leaflet. The aortic, tricuspid and pulmonary valves were normal in structure and function Discussion Echocardiography is a crucial imaging modality in a patient with multiple systemic emboli to rule out cardio-embolic source of embolization. TEE is of added value along with TTE in better definition of masses and detection of IE related complication. While the patient was prepared for the vascular surgery to secure the ischemic limb his sensorium was disturbed and became unconscious immediate brain computed tomography showed severe intracranial hemorrhage and the patient died. Conclusions Patient with chronic kidney disease and on hemo-dialysis are highly vulnerable to health care related infective endocarditis and high clinical suspicion should be given in a situation of prolonged fever and embolic events. Mitral valve abscess is a rare complication of infective endocarditis and if occurs it leads to increase mortality. TEE should be an integral part of management of patients with IE to role out serious complications. Abstract P835 Figure. Mitral valve infective endocarditis

3327Increasing incidence of cardiac device related endocarditis over the past ten years: a single center analysis

Abstract Background Cardiac device related infective endocarditis (CDIE) is an increasing problem in the current cardiology practice, related to high mortality and morbidity. Recent trends have shown an increase in cardiac device placement, which remains a risk factor for developing CDIE. We performed a retrospective analysis of all patients admitted to our hospital. The aim of our study was to identify a possible correlation between the amount of device placements and the incidence of CDIE. Methods All patients, aged 18 years or above, diagnosed and treated for IE in our hospital in the 11 years between January 1st 2007 and December 31st 2017 were retrospectively identified. The amount of cardiac device placements was meticulously kept up to date by the administrative department. Due to the retrospective nature of our study no approval of the local ethics committee was required. Results A total of 33 patients with proven CDIE were identified There were no CDIE documented in 2007,2009 and 2010. 2008 showed 2 CDIE (16.7%) whereas the last 4 years of the study showed a mean incidence of 5.75 IE per year. Our population was predominantly male (84.8%) and nearly a third of the population died during hospital stay. The mean age of the population was 73.9 years old. Three quarters of the population underwent surgery and 24 patients out of these underwent device removal, the remaining 2 patients underwent valve replacement or catheter removal. Half of the patients had early-onset or procedure-related IE (&lt;12 months post procedure). The remaining cases were defined as late onset IE. Overall, 80% of CDIE developed within 3 years after the procedure. The most prevalent causative organisms in our CDIE population were Staphylococci (68%) followed by Streptococci (20%). Eight out of 33 cases appeared to be culture negative (24.2%). We sought to correlate these findings to the amount of cardiac device procedures (de novo implantations and replacements) as of 2004 (to compensate for the possible 3-year delay). The number of CD procedures increased by nearly 400% over the course of these 14 years. Patient demographics Conclusions The incidence of CDIE has increased in our population over the past 11 years. This increase runs parallel with the expansion of the number of devices implanted. About half of CDIE occur within 1 year of the procedure defined as early onset CDIE, but the presence of a cardiac device remains a risk factor for IE even thereafter. Causative organisms in our study for CDIE specifically appear to coincide with the results from other studies done in more general populations, with Staphylococci remaining the most prevalent organisms. As patients with cardiac devices implanted appear to be at increased risk for IE, one might add these to the group of patients requiring IE-prophylaxis, especially because of the high mortality rate of IE, which appears to be even higher for CDIE.

TCT-568 Effectiveness and Safety of Vacuum-Assisted Thrombectomy Device (AngioVac) for Extraction of Vegetations on Intra-Cardiac Devices and Valves Prior to Device Removal: A Single Center Experience

Cardiac device–related infective endocarditis is on the rise. Complete device and lead removal is recommended for favorable outcomes. However, there is a risk for embolization of device-related vegetations during the procedure. The AngioVac (AngioDynamics, Latham, New York) can be used as an

Lead-Related Infective Endocarditis in Latvia: A Single Centre Experience.

Background and Objectives: Over the last five decades cardiac implantable electronic devices (CIED) have become established as the mainstay for the treatment of permanent bradycardias, chronic heart failure and dangerous heart rhythm disturbances. These devices improve survival and quality of life in many patients. However, infections associated with CIED implantation, particularly lead-related infective endocarditis (LRIE), can offset all benefits and make more harm than good for the patient. To date, there are no other studies in Latvia, addressing patients with lead-related infective endocarditis. The objective of this study was to identify the most common pathogens associated with LRIE and their antimicrobial resistance and to identify possible risk factors of patients who present with LRIE. Materials and Methods: The study was performed retrospectively at Pauls Stradins Clinical University Hospital (PSCUH). The study included patients who were referred to PSCUH due to LRIE for lead extraction. Patients were identified from procedural journals. Information about isolated microorganisms, patient comorbidities and visual diagnostics data was taken from patient records. Results: Forty-nine patients with CIED related infective endocarditis were included in the study, 34 (69.4%) were male, median age of all patients was 65.0 (50.5–73.0) years, median hospital stay was 15.5 (22.0–30.5) days. Successful and complete lead extraction was achieved in all patients. Thirty-two (65.3%) had received antibiotics prior to blood sample. Only in 31 (63.3%) positive culture results were seen. The most common isolated pathogens were Staphylococcus aureus (23.5%) and coagulase negative staphylococci (23.5%). Other bacteria were isolated considerably less often. The atrial lead was most common location for lead vegetations, seen in 50.0% of cases. Five (10.2%) patients have died due to the disease. Conclusions: Lead-related infective endocarditis is a major complication of cardiac implantable electronic devices with considerable morbidity and mortality, which in our study was as high as 10.2%.