Clinical characteristics, treatment, and mortality in device-related versus left-sided infective endocarditis: a nationwide study from the NIDUS registry

Abstract Background Cardiac implantable electronic device (CIED)-related infective endocarditis (IE) presents distinct diagnostic and therapeutic challenges due to its unique characteristics and the limited evidence supporting treatment guidelines compared with valvular IE. Understanding the differences between these patient groups may be crucial for optimising patient care. Purpose To examine clinical characteristics, treatment strategies, and in-hospital mortality in patients with isolated CIED-related IE compared with left-sided IE. Methods We included patients with first-time IE using nationwide data from the NatIonal Danish Endocarditis StUdieS (NIDUS) registry (2016-2021) and categorised them into (1) isolated CIED-related IE and (2) left-sided IE. Multivariable logistic regression analysis was used to estimate an odds ratio (OR) for in-hospital mortality for CIED-related versus left-sided IE, adjusted for sex, age, microbial aetiology, heart failure, diabetes, active cancer, liver disease, and chronic obstructive pulmonary disease. Results A total of 355 patients with isolated CIED-related IE and 2,888 patients with left-sided IE were included. Patients with CIED-related IE were older (median age: 76.0 interquartile range (IQR): 68.2-81.7 vs. 74.1 years IQR: 65.1-80.9) and had a higher prevalence of males (78.6% vs. 66.5%), diabetes (33.5% vs. 23.0%), and heart failure (45.1% vs. 15.3%) than those with left-sided IE. Furthermore, patients with CIED-related IE had higher proportions of Staphylococcus aureus (36.9% vs. 30.4%), coagulase-negative staphylococci (CoNS) (9.6% vs. 5.5%), and blood culture-negative IE (12.4% vs. 7.4%), but a lower proportion of Streptococcus species (16.3% vs. 33.1%) (Figure). CIED removal was performed in 78.3% of patients with CIED-related IE. The prevalence of in-hospital mortality was 11.6% in patients with CIED-related IE and 18.3% in those with left-sided IE (P=0.002). In adjusted analyses, CIED-related IE was associated with significantly lower in-hospital mortality compared with left-sided IE (OR: 0.44 95% CI: 0.31-0.63). Conclusions In this nationwide study, patients with CIED-related IE had a higher prevalence of Staphylococcus species compared with patients with left-sided IE, and CIED removal was performed in most patients with CIED-related IE. Additionally, CIED-related IE was associated with lower in-hospital mortality. Future studies may consider different treatment and preventive strategies for this cohort compared with left-sided valvular IE.