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Patients receiving implanted cardiac devices such as defibrillators and pacemakers are at risk for potentially fatal infections involving the heart, a new study shows.

Infective endocarditis is an infection of the endocardial surface of the heart or valves caused by bacteria or other pathogen in the bloodstream. In cases of cardiac device infective endocarditis (CDIE), the infection can occur during the implantation of the cardiac device or other invasive or intravascular procedure after device implantation.

Lead study author Eugene Athan, M.D., of Barwon Health in Australia worked with colleagues from around the world, including doctors from the Duke Clinical Research Institute and Duke University Medical Center in the United States, to examine the characteristics and outcome of health care associated CDIE and compare mortality rates to those patients who had their cardiac device removed. The prospective cohort study used data from the International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS), conducted from June 2000 through August 2006 in 61 centers in 28 countries.

“Cardiac electronic devices, including permanent pacemakers and implantable cardioverter-defibrillators (ICDs), are increasingly implanted worldwide, with estimates of more than 4.2 million patients with a permanent pacemaker or ICD implanted in the United States between 1993 and 2008. Cardiac device infection is a serious, emerging disease with a 210 percent increase in incidence between 1993 and 2008,” said study researchers. “The management of cardiac device infective endocarditis (CDIE) is complex and usually requires prolonged antibiotic therapy, percutaneous or surgical removal of the device, and possible device reimplantation.”

The study showed that patients with infective endocarditis involving implanted cardiac devices suffered high rates of CDIE complications, including the persistent presence of bacteria in the blood, heart failure, valve infections and death. The CDIE infections were predominantly staphylococcal.

Patients who had their cardiac device removed had a better outcome. In the study, 19.9% of patients who underwent cardiac device removal during the initial hospitalization died in the first year versus 38.2% of patients who did not have their device removed.

The estimated treatment cost for cardiac device infective endocarditis is $146,000 per patient in U.S. hospitals.

The study Heart Infection Involving Implantable Cardiac Device Associated with High Rate of Complications, Risk of Death appears in the April 25, 2012 issue of the Journal of the American Medical Association.

“The high rates of mortality emphasize the need for improved preventive measures, including optimal skin decontamination and appropriate antibiotic administration at the time of cardiac device insertion or manipulation, as well as careful attention to any invasive or intravascular procedures performed after device implantation,” the authors wrote.

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