Cardiac device-related endocarditis complicated by spinal abscess

Yasser Rodriguez, Arnold J. Greenspon, Muhammad R. Sohail, Roger Carrillo

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)269-274
Number of pages6
JournalPACE - Pacing and Clinical Electrophysiology
Volume35
Issue number3
DOIs
StatePublished - Mar 1 2012

Fingerprint

Endocarditis
Abscess
Equipment and Supplies
Device Removal
Methicillin
Hospital Records
Enterococcus faecalis
Coagulase
Methicillin-Resistant Staphylococcus aureus
Bacteremia
Infection
Staphylococcus
Nervous System
Staphylococcus aureus
Fever
Referral and Consultation
Tomography
Magnetic Resonance Imaging
Mortality

Keywords

  • abscess
  • defibrillators
  • endocarditis
  • infection
  • pacemaker
  • spine

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Cardiac device-related endocarditis complicated by spinal abscess. / Rodriguez, Yasser; Greenspon, Arnold J.; Sohail, Muhammad R.; Carrillo, Roger.

In: PACE - Pacing and Clinical Electrophysiology, Vol. 35, No. 3, 01.03.2012, p. 269-274.

Research output: Contribution to journalArticle

Rodriguez, Yasser ; Greenspon, Arnold J. ; Sohail, Muhammad R. ; Carrillo, Roger. / Cardiac device-related endocarditis complicated by spinal abscess. In: PACE - Pacing and Clinical Electrophysiology. 2012 ; Vol. 35, No. 3. pp. 269-274.
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abstract = "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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