Nonvalvular Cardiovascular Device–Related Infections

Abstract

M ore than a century ago, Osler took numerous syndrome descriptions of cardiac valvular infection that were incomplete and confusing and categorized them into the cardiovascular infections known as infective endocarditis.Because he was both a clinician and a pathologist, he was able to provide a meaningful outline of this complex disease.Technical advances have allowed us to better subcategorize infective endocarditis on the basis of microbiological etiology.More recently, the syndromes of infective endocarditis and endarteritis have been expanded to include infections involving a variety of cardiovascular prostheses and devices that are used to replace or assist damaged or dysfunctional tissues (Table 1).Taken together, infections of these novel intracardiac, arterial, and venous devices are frequently seen in medical centers throughout the developed world.In response, the American Heart Association's Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease wrote this review to assist and educate clinicians who care for an increasing number of patients with nonvalvular cardiovascular device-related infections.Because timely guidelines 1,2 exist that address the prevention and management of intravascular catheter-related infections, these device-related infections are not discussed in the present Statement.This review is divided into two broad sections.The first section examines general principles for the evaluation and management of infection that apply to all nonvalvular cardiovascular devices.Despite the marked variability in composition, structure, function, and frequency of infection among the various types of nonvalvular cardiovascular devices reviewed in this article, there are several areas of commonality for infection of these devices.These include clinical manifestations, microbiology, pathogenesis, diagnosis, treatment, and prevention.The second section addresses each device and describes unique clinical features of infection.Each device is placed into one of 3 categoriesintracardiac, arterial, or venous-for discussion.The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel.Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.