Clinical manifestations of device-related infective endocarditis in cardiac resynchronization therapy recipients
The aim of the study was to analyse microbiological characteristics and clinical manifestations of cardiac device-related infective endocarditis (CDRIE) in cardiac resynchronization therapy (CRT) recipients, and to compare the diagnostic value of modified Duke (MDC) versus modified Duke lead criteri...
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Published in | Archives of medical science Vol. 17; no. 3; pp. 638 - 645 |
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Main Authors | , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Poland
Termedia Publishing House
01.01.2021
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Subjects | |
Online Access | Get full text |
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Summary: | The aim of the study was to analyse microbiological characteristics and clinical manifestations of cardiac device-related infective endocarditis (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).
The study population comprised 765 consecutive CRT patients from a high-volume, tertiary care centre from 2002 to 2015. All patients were screened for CDRIE.
During a median follow-up of 1692 days (range: 457-3067) 5.36% of patients (
= 41) developed CDRIE, which was accompanied by CRT pocket infection in 17.1% (
= 7) and recurrent pulmonary infection or pulmonary embolism in 29.3% (
= 12). Fever was present in 95.1% of patients (
= 39), whereas blood cultures were positive in 65.9% (
= 27).
was the most prevalent pathogen in 59.3% (
= 16), Gram-negative bacteria in 25.9% (
= 7). Transoesophageal echocardiography showed intracardiac vegetations in 73.2% of patients (
= 30). Non-different pathogen types with the most common methicillin-sensitive
were observed for early versus late CDRIE (endocarditis ≤ 6 vs. > 6 months from CRT or other device-related procedure). All 3 inflammatory markers (C-reactive protein, white blood cells, procalcitonin) were normal in 4.9% of patients (
= 2). MDC versus MDLC indicated definite CDRIE in 48.8% versus 80.5%, respectively (
= 0.003).
Fever 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
, Gram-negative bacteria accounted for a quarter of CDRIE. Modified Duke lead criteria proved superior to MDC. |
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Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 1734-1922 1896-9151 |
DOI: | 10.5114/aoms.2018.75893 |