560. Correlation of Fever and Elevated Leukocyte Count with Chest CT Findings of Septic Pulmonary Emboli in Cardiac Device Related Infections
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Cardiac device implantation and complication rates have increased steadily in recent years. Cardiac device infections (CDI) can present with local or systemic infections, with or without endocarditis. Risk of distant embolism related with larger cardiac vegetations has been reported in prior studies as well as risk for pulmonary embolism complicating percutaneous lead extraction. In the literature, there are a few case reports regarding findings of septic pulmonary emboli as a complication for CDI, but little is known about the associated clinical presentation in these patients.
Methods: We retrospectively reviewed a cohort of 148 subjects referred for laser lead extraction of an infected cardiac device from January 2004 to September 2008. Demographic data and clinical characteristics on presentation were recorded in a database. All patients underwent a chest radiograph and most of them had Computerized Tomography (CT) scan of the chest without contrast as part of our preoperative protocol. The clinical and laboratory characteristics of those that were diagnosed with infective endocarditis related to CDIs and septic pulmonary emboli were compared to those without emboli.
Results: 92 subjects (62.2%) presented without fever (defined as T >38.C) and a normal total leukocyte count (WBC). Five subjects (3.3%) had no fever and elevated WBC count. 37 subjects (25%) had fever with normal WBC count. 14 subjects (9.5%) had fever and elevated WBC count. The average leukocyte count was 17.4. Within this last subgroup, 8 subjects (57.1%) had a positive CT chest for septic pulmonary emboli. All these patients had a normal preoperative chest radiograph.
Conclusion: Over half of subjects in a cohort of CDIs that presented with fever and leukocytosis were diagnosed as having infective endocarditis with CT findings consistent with pulmonary septic emboli. Preoperative chest CT should be considered as additional diagnostic tool in this setting as the diagnosis of septic pulmonary emboli carries inherent implications for risk stratification and management.
Ella Ariza-Heredia, MD, Infectious Diseases, Mayo Clinic, Rochester, MN, Roger Carrillo, MD, Cardiothoracic Surgery, University of Miami, Miami, FL, Juan Garisto, MD, University of Miami, Miami, FL and  E. J. Ariza-Heredia, None..
J. D. Garisto, None..
R. Carrillo, None.