Cardiac device related infective endocarditis (CDRIE): the POL-ENDO (Polish infective endocarditis registry) substudy

Background

The increasing use of cardiac implantable devices has led to a rising incidence of CDRIE. Device-associated infections may represent a distinct clinical phenotype with different comorbidity burden, complications and therapeutic strategies compared with non-device infective endocarditis (non-CDRIE).

Aims

To assess the clinical profile and treatment outcomes of CDRIE, through a comprehensive examination of data sourced from POL-ENDO.

Methods

A prospective multicenter observational cohort study in IE patients from 183 medical centers in Poland registered between August 2022 and August 2025 was conducted. The demographic, clinical, microbiological and treatment outcome data were assessed.

Results

Among 2,824 IE patients, 308 (10.9%) were classified as CDRIE. CDRIE patients possessed a higher burden of comorbidities, including hypertension (74.6% vs. 54.2%, p<0.001), diabetes (39.3% vs. 25.1%, p<0.001), and CKD (41.6% vs. 22.9%, p<0.001). Overall clinical status was poorer in the CDRIE group, reflected by a higher prevalence of HF (76.4% vs. 53.7%, p<0.001), CAD (52.0% vs. 24.4%, p<0.001), and AF (64.7% vs. 31.2%, p<0.001). Recent dental procedures were more frequent among non-CDRIE patients (7.9% vs. 3.1%, p=0.011), while PCI (32.5% vs. 11.4%, p<0.001) and ablation (7.2% vs. 1.8%, p<0.001) were more common in CDRIE. CDRIE patients less often presented with fever (41.6% vs. 49.8%, p=0.020), cardiac murmur (5.8% vs. 29.0%, p<0.001), and peripheral embolism (0.9% vs. 3.8%, p=0.025), but more frequently reported dyspnoea (44.9% vs. 38.0%, p=0.049). Staphylococcus aureus predominated in CDRIE (22.1% vs. 11.8%, p<0.001). Viridans streptococci (0.9% vs. 4.1%, p=0.017) and enterococci (8.1% vs. 13.2%, p=0.033) were more frequent in non-CDRIE. BCNIE was more common in CDRIE (41.6% vs. 33.0%, p=0.011). Advanced imaging was used less often in CDRIE (CT 32.1% vs. 44.7%, p<0.001; MRI 1.4% vs. 6.8%, p=0.001). Non-CDRIE patients developed more in-hospital complications, including HF (33.6% vs. 20.4%, p<0.001), embolic events (12.7% vs. 4.1%, p<0.001), and underwent surgery more often (36.7% vs. 10.9%, p<0.001). Electrode extraction was performed in 76.1% of CDRIE patients. CDRIE was not associated with higher mortality.

Conclusion

Prior history of IE was less frequent in the CDRIE group. CDRIE patients presented with a greater prevalence of hypertension, diabetes, and CKD. Overall clinical status was poorer in the CDRIE group. Clinically, CDRIE was characterized by a less typical presentation. Staphylococcus aureus predominated in CDRIE. Blood-culture-negative IE was more common in CDRIE. New imaging techniques were used less often in CDRIE. CDRIE patients developed fewer in-hospital complications and underwent surgery less often. CDRIE was not associated with higher mortality.

Greater diagnostic vigilance and device-oriented management strategies for CDRIE are required, as atypical presentation may delay recognition.