Clinical Predictors of Cardiovascular Implantable Electronic Device-Related Infective Endocarditis

Authors

Errata

This article is corrected by:

  1. Errata: Erratum Volume 35, Issue 11, 1405, Article first published online: 7 November 2012

  • Disclosures: All < $10,000.

  • PAF: Honoraria/Consultant: Medtronic, Guidant, Astra Zeneca.

  • Sponsored research: Medtronic, Astra Zeneca via Beth Israel, Guidant, St. Jude, Bard.

  • Intellectual property rights: Bard EP, Hewlett Packard, Medical Positioning, Inc.

  • DZU: Research: American Heart Association.

  • Honoraria/Consultant: Biotronik, Cubist, TyRx Pharma, Inc.

  • DLH: Honoraria: Medtronic, Boston Scientific, St. Jude Medical, ELA Medical, Biotronik.

  • Royalty payments: UpToDate; Wiley-Blackwell.

  • Medical advisory board: Boston Scientific, St. Jude Medical, Pixel Velocity.

  • Steering committee member: Medtronic, St. Jude Medical.

  • LMB: Royalty payments: UpToDate.

  • Editorship: Massachusetts Medical Society (Journal Watch Infectious Diseases); ACP/PIER editorial consultant.

  • MRS: Honoraria/Consultant: TyRx Pharma, Inc.

  • All other authors: No disclosures.

Address for reprints: Katherine Y. Le, M.D., M.P.H., Mayo School of Graduate Medical Education, 200 First Street SW, Rochester, MN 55905. Fax: 507-255-7767; e-mail: le.katherine1@mayo.edu

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. (PACE 2011; 34:450–459)

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