Affiliation:
1. Department of Cardiology, Congenital Heart Diseases and Electrotherapy,
Silesian Centre for Heart Diseases, Zabrze, Poland
2. Department of Cardiology, School of Medicine with the Division of Dentistry, Zabrze,
Poland
Abstract
IntroductionThe aim of the study was to analyse microbiological charac�teristics and clinical manifestations of cardiac device-related infective endo�carditis (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 methodsThe study population comprised 765 consecutive
CRT patients from a high-volume, tertiary care centre from 2002 to 2015. All
patients were screened for CDRIE.ResultsDuring a median follow-up of 1692 days (range: 457–3067) 5.36%
of patients (n = 41) developed CDRIE, which was accompanied by CRT pocket
infection in 17.1% (n = 7) and recurrent pulmonary infection or pulmonary
embolism in 29.3% (n = 12). Fever was present in 95.1% of patients (n = 39),
whereas blood cultures were positive in 65.9% (n = 27). Staphylococcus was
the most prevalent pathogen in 59.3% (n = 16), Gram-negative bacteria in
25.9% (n = 7). Transoesophageal echocardiography showed intracardiac veg�etations in 73.2% of patients (n = 30). Non-different pathogen types with the
most common methicillin-sensitive Staphylococcus aureus were observed for
early versus late CDRIE (endocarditis ≤ 6 vs. > 6 months from CRT or other de�vice-related procedure). All 3 inflammatory markers (C-reactive protein, white
blood cells, procalcitonin) were normal in 4.9% of patients (n = 2). MDC versus
MDLC indicated definite CDRIE in 48.8% versus 80.5%, respectively (p = 0.003).ConclusionsFever 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 Staphylococci, Gram-negative bacteria accounted for a quarter of
CDRIE. Modified Duke lead criteria proved superior to MDC.
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