553. Clinical Predictors of Cardiovascular Implantable Electronic Device-related Infective Endocardititis
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Cardiovascular implantable electronic device (CIED)-related infective endocarditis (CIED-IE) is a serious complication of CIED infection that may require a longer duration of antimicrobial therapy (up to 6 weeks) and delayed (up to 2 weeks) reimplantation of a new device. At present, diagnosis of CIED-IE requires transesophageal echocardiography (TEE) in most adult patients, which is an expensive, and an invasive procedure with potential risk.
Objective: To identify clinical predictors associated with an increased risk of CIED-IE.
Methods: We retrospectively reviewed all cases of CIED infection at Mayo Clinic from 1991-2008. CIED-IE was confirmed using clinical and echocardiographic criteria. Clinical predictors of CIED-IE were identified using logistic regression. Candidate variables included comorbid conditions, presenting signs and symptoms, and laboratory parameters.
Results: 270 patients with CIED infection were hospitalized during the study period; 79 (29%) had CIED-IE. In univariate setting, odds of eventual diagnosis of CIED-IE were greater among patients who were immunocompromised, had an implanted catheter, congestive heart failure, presented with fever, malaise, hypotension, metastatic infectious foci, leukocytosis, anemia, or are bacteremic on admission. Conversely, odds of CIED-IE were low in patients who presented with inflammatory signs at generator pocket. Significant predictors of CIED-IE in multivariate analysis are listed in Table. However, when incorporated in one final model, only fever and bacteremia remained significant independent predictors.
Conclusion: Our findings suggest that fever and bacteremia on admission are independent predictors of CIED-IE. Patients with either of these risk factors should undergo TEE for further evaluation and management of CIED infection.
Table: Predictors of CIED-IE by multivariable analysis.
Clinical predictorsOR [95% CI]P
Immunocompromise1.9 [1.1 - 3.5]<0.05
Leukocytosis2.3 [1.4 - 4.1]<0.01
Anemia2.0 [1.1 - 3.7]<0.05
Fever3.5 [1.5 - 8.2]<0.01
Positive blood culture3.0 [1.4 - 6.6]<0.01
David Hayes, MD, Baddour Larry, MD2, Katherine Y. Le, MD, MPH3, Friedman Paul, MD2, Muhammad Sohail, MD2, James Steckelberg, MD, FIDSA4, Wilson Walter, MD2 and  K. Le, None..
M. Sohail, None. 
F. M. Paul,
Medtronic Role(s): Grant Investigator, Research Relationship, Scientific Advisor (Review Panel or Advisory Committee), Received: Research Support.
Guidant Role(s): Research Relationship, Scientific Advisor (Review Panel or Advisory Committee).
St. Jude Medical Role(s): Research Relationship.
D. M. Hayes,
Medtronic Role(s): Consultant, Research Relationship.
Guidant Role(s): Research Relationship.
St. Jude Medical Role(s): Research Relationship.
W. M. Walter, None..
J. M. Steckelberg, None. 
B. M. Larry,
Up To Date Role(s): Other, Royalty payment.
Elsevier Role(s): Other, Royalty payment., (1)Mayo Clinic, College of Medicine, Rochester, MN, (2)Mayo School of Graduate Medical Education, Rochester, MN, (3)Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Rochester, MN