1112. Fever of Unknown Origin as Initial presentation for Cardiac Device Infection
Session: Poster Abstract Session: Infections of Cardiovascular Devices
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Fever of unknown origin (FUO) is a challenging disease due to the many potential causes. We analyzed our experience of infective device endocarditis (IDE) in patients presenting with primary diagnosis of FUO.

Methods:We retrospectively reviewed all patients who underwent cardiac device extraction and initial diagnosis of FUO referred to our institution between January 2004 and December 2009. Clinical data and outcomes of subjects were analyzed. All patients underwent history, physical examination, laboratory tests (serological, blood cultures, immunological), diagnostic imaging and transesophageal echocardiogram (TEE). FUO was defined using clinical criteria established by Petersdorf and Beeson.

Results: FUO was identified in 13 patients (12 males, 1 female, mean age 72.15±12.2, range 51-92). The majority of FUO were device-related endocarditis (12, 92.3%). Generator pocket was identified as the source of infection in one case. Prior assessments for other etiologies were negative. Intraoperative TEE showed 10 intracardiac vegetations attached to the lead. The devices removed were 9 (69.2%) implantable cardiac-defibrillators, 3 (23%) pacemakers, and 1 (7.7%) biventricular-ICD. Lead tip cultures were positive in 5 cases isolating Methicillin sensitive Staphylococcus aureus (3, 23%) and Methicillin sensitive Staphylococcus epidermidis (2, 15.4%). Reimplantation of a new device was performed in 6 patients. All patients were discharged home after complete course of antibiotic with complete resolution of the cause of fever.

Conclusion: Clinical suspicion for device-related endocarditis needs to be considered in patients with FUO. TEE was useful in diagnosis of intracardiac vegetations.

Subject Category: J. Clinical practice issues

Roger Carrillo, MD and Juan D. Garisto, MD, Cardiothoracic Surgery, University of Miami Hospital Miller School of Medicine, Miami, FL


R. Carrillo, Spectranetics: Speaker's Bureau, Speaker honorarium

J. D. Garisto, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.