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Pacing Clin Electrophysiol. 2011 Apr;34(4):450-9. doi: 10.1111/j.1540-8159.2010.02991.x. Epub 2011 Jan 5.

Clinical predictors of cardiovascular implantable electronic device-related infective endocarditis.

Author information

  • 1Mayo School of Graduate Medical Education, Mayo Clinic, Rochester, Minnesota, USA. le.katherine1@mayo.edu

Erratum in

  • Pacing Clin Electrophysiol. 2012 Nov;35(11):1405. Virkram, H R [corrected to Vikram, H R].

Abstract

BACKGROUND:

Cardiovascular implantable electronic device (CIED)-related infective endocarditis (CIED-IE) is a serious complication of cardiac device infection and is associated with increased mortality. At present, there exist no criteria to predict CIED-IE in patients who present with CIED infection.

METHODS:

We retrospectively reviewed all cases of CIED infection seen at Mayo Clinic Rochester between 1991 and 2008. CIED-IE was classified using pathologic and clinical criteria. Clinical predictors of CIED-IE were identified using logistic regression, and quantified using a summary score and plotted against the distribution of CIED-IE.

RESULTS:

Ninety-three (22.4%) of the 416 patients with CIED infection had CIED-IE. Host factors including chronic immunomodulator therapy exclusive of corticosteroid (odds ratio [OR], 3.79 [confidence interval (CI) 1.10, 13.04]), chronic corticosteroid therapy (OR, 2.15 [CI 0.93, 5.00]), hemodialysis (OR, 3.24 [CI 1.39, 7.55]), or remote infection (OR, 1.77 [CI 0.99, 3.14]) were associated with increased odds of CIED-IE. Patients with CIED-IE were at increased odds of presenting with fever (OR, 3.78 [CI 1.93, 7.40]), or malaise (OR, 1.87 [CI 1.02, 3.41]), and have findings of leukocytosis (OR, 3.61 [CI 1.51, 8.62]). In marked contrast, they were at decreased odds of exhibiting signs/symptoms of infection at the generator pocket site (OR, 0.19 [CI 0.10, 0.36]). Summary scores of 6 and 11 predicted CIED-IE in approximately 50% and 90% of cases, respectively.

CONCLUSIONS:

Certain comorbid conditions and systemic manifestations of infection were associated with CIED-IE. In contrast, pocket site infection was negatively associated with CIED-IE. These findings should assist clinicians in identifying patients who would more likely benefit from further investigation of CIED-IE with transesophageal echocardiography.

©2010, The Authors. Journal compilation ©2010 Wiley Periodicals, Inc.

PMID:
21208230
[PubMed - indexed for MEDLINE]
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