Clinical manifestations of device-related infective endocarditis in cardiac resynchronization therapy recipients.

INTRODUCTION

The aim of the study was to analyse microbiological characteristics and clinical manifestations of cardiac device-related infective endocarditis (CDRIE) in cardiac resynchronization therapy (CRT) recipients, and to compare the diagnostic value of modified Duke (MDC) versus modified Duke lead criteria (MDLC; including to MDC local infection and pulmonary infection or embolism as major criteria).

MATERIAL AND METHODS

The study population comprised 765 consecutive CRT patients from a high-volume, tertiary care centre from 2002 to 2015. All patients were screened for CDRIE.

RESULTS

During a median follow-up of 1692 days (range: 457-3067) 5.36% of patients ( = 41) developed CDRIE, which was accompanied by CRT pocket infection in 17.1% ( = 7) and recurrent pulmonary infection or pulmonary embolism in 29.3% ( = 12). Fever was present in 95.1% of patients ( = 39), whereas blood cultures were positive in 65.9% ( = 27). was the most prevalent pathogen in 59.3% ( = 16), Gram-negative bacteria in 25.9% ( = 7). Transoesophageal echocardiography showed intracardiac vegetations in 73.2% of patients ( = 30). Non-different pathogen types with the most common methicillin-sensitive were observed for early versus late CDRIE (endocarditis ≤ 6 vs. > 6 months from CRT or other device-related procedure). All 3 inflammatory markers (C-reactive protein, white blood cells, procalcitonin) were normal in 4.9% of patients ( = 2). MDC versus MDLC indicated definite CDRIE in 48.8% versus 80.5%, respectively ( = 0.003).

CONCLUSIONS

Fever is the most common symptom of CRT-related CDRIE, and transoesophageal echocardiography allows vegetations to be visualised in nearly 3/4 of patients with CDRIE. Although the most common pathogens were , Gram-negative bacteria accounted for a quarter of CDRIE. Modified Duke lead criteria proved superior to MDC.