Key result
Device-related endocarditis carries a ~1.5% incidence of spinal abscess.
Why the study?
The association between cardiac device-related endocarditis and spinal abscess has not been fully described.
Observational (n=384)
Yes
Spinal abscess is a rare (1.5%) but severe complication of cardiac device-related endocarditis, highlighting the need for early recognition and device removal in patients presenting with bacteremia and neurological signs.
Alerts clinicians to rare spinal abscess in device endocarditis; hypothesis-generating for incidence and screening protocols.
BACKGROUND: Infective endocarditis is the most serious manifestation of cardiac device infection and metastatic seeding of distant sites has been reported. However, the association between device-related endocarditis and spinal abscess has not been fully described. METHODS: We reviewed hospital records at three high-volume cardiovascular referral centers from January 2005 to October 2010. Device-related endocarditis was confirmed in all cases with positive blood cultures and transesophageal echocardiogram revealing lead and/or valvular vegetations. Six patients with spinal abscesses in association with device-related endocarditis were identified. RESULTS: A total of 384 patients met the clinical criteria for device-related endocarditis. Among these, infection was complicated by spinal abscess formation in six (1.5%) cases. The mean age of patients was 69.3 ± 11.8 years (47-82 years). The predominant clinical manifestations in these six patients included a recent history of fever (six), malaise (four), and neurological or meningeal signs (five). Spinal abscesses were diagnosed by magnetic resonance imaging in two and computed tomography scans in four of the cases. The causative pathogens were methicillin-resistant Staphylococcus aureus (three), methicillin-sensitive S. aureus (one), coagulase-negative Staphylococci (two), and Enterococcus fecalis (one). All patients underwent complete device removal with no procedure-related complications. Two patients died in the hospital, two were discharged with permanent neurological deficits, and the remaining two recovered with no permanent neurologic sequelae. CONCLUSION: Device-related endocarditis must be considered in patients who present with a spinal abscess and bacteremia. Early recognition of this scenario is imperative in order to avoid permanent neurological sequelae and patient mortality. Early imaging, appropriate parenteral antimicrobial therapy, and expedited removal of all cardiac hardware are pivotal for optimal management.
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Rodriguez et al. (2011) conducted an observational in Device-related endocarditis (n=384). Device-related endocarditis was evaluated on Spinal abscess formation. Among patients with device-related endocarditis, spinal abscess formation occurred as a complication in 1.5% of cases.
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