1031. Lack of Value of Routine Transesophageal Echocardiography (TEE) in the Management of Cardiovascular Implantable Electrophysiologic Device (CIED) Infections
Session: Poster Abstract Session: Diagnostic Procedures in Clinical Practice
Saturday, October 22, 2011
Room: Poster Hall B1
Background: A TEE is recommended in the diagnostic evaluation of patients with proven or suspected CIED infections.  The impact of TEE results on management and outcome in CIED infections is unclear.

Methods: We performed a retrospective study of hospitalized patients with CIED infections at our institution between 2000 and 2009. Data collected included:  demographics, Charlson comorbidity score, device specific information pocket versus lead-associated endocarditis (LAE), microbiology, TEE results (abnormal defined as lead or valve vegetation) and outcomes (device removal, discharge or death due to CIED infection). Patients with LAE were identified by positive lead cultures and/or blood cultures in the absence of pocket infection.  Patients with pocket infections were identified by documentation of local evidence of infection.  Outcomes (lead extraction rates, mortality, and duration of antibiotics) were compared in patients who had a TEE performed or not using χ2 and ANOVA.  A p≤0.05 was considered significant.

Results: 109 patients were included in the study (41 LAE and 68 pocket infections).  The two study groups were comparable in terms of mean age and gender distribution. Patients with LAE were more likely than those with pocket infections to have a TEE (68.3% vs. 27.9%, p<0.0001) and have an abnormal TEE (75% vs. 16.7%, p<0.0001). Overall, 81.5% of patients had the device leads extracted and there were no differences in lead extraction rates in either group based on having a TEE performed.  The overall mortality rate was 8.3%, with higher mortality in the LAE group compared to the pocket infection group (17.5% vs. 2.9%, p=0.008).  An abnormal TEE did not predict mortality (17.4% vs. 9.1%, p=0.41).  While patients who had a TEE performed received a longer duration of antibiotics (34.3±17.2 vs. 20.3±11.6, p<0.0001), there was no difference in duration of antibiotics based on an abnormal vs. normal TEE (33.4±16.1 vs. 35.6±18.9, p=0.68).

Conclusion: TEE findings did not influence the rate of lead removal, duration of antibiotics or the mortality rate in patients with CIED.  Further studies should be performed to determine which patients might benefit from the use of TEE in CIED infections.

Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

Hanady Daas, MD1, Joel Fishbain, MD2, Hussein Othman, MD1, Susan Szpunar, PhD3, Michael Tucciarone, MD1 and Leonard Johnson, MD2, (1)St John Hospital and Medical Center, Grosse Pointe Woods, MI, (2)Medicine, St. John Hospital and Medical Center, Grosse Pointe Woods, MI, (3)St. John Hospital and Medical Center, Grosse Pointe Woods, MI


H. Daas, None

J. Fishbain, None

H. Othman, None

S. Szpunar, None

M. Tucciarone, None

L. Johnson, None

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