Clinical manifestations of device-related infective endocarditis in cardiac resynchronization therapy recipients

Ewa Jędrzejczyk-Patej; Michał Mazurek; Oskar Kowalski; Adam Sokal; Agnieszka Liberska; Mariola Szulik; Tomasz Podolecki; Zbigniew Kalarus; Radosław Lenarczyk

doi:10.5114/aoms.2018.75893

Clinical manifestations of device-related infective endocarditis in cardiac resynchronization therapy recipients

Arch Med Sci. 2018 Aug 7;17(3):638-645. doi: 10.5114/aoms.2018.75893. eCollection 2021.

Authors

Ewa Jędrzejczyk-Patej¹, Michał Mazurek¹, Oskar Kowalski¹, Adam Sokal¹, Agnieszka Liberska¹, Mariola Szulik¹, Tomasz Podolecki¹, Zbigniew Kalarus², Radosław Lenarczyk¹

Affiliations

¹ Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Zabrze, Poland.
² Department of Cardiology, School of Medicine with the Division of Dentistry, Zabrze, Poland.

Abstract

Introduction: 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).

Material and methods: 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.

Results: During a median follow-up of 1692 days (range: 457-3067) 5.36% of patients (n = 41) developed CDRIE, which was accompanied by CRT pocket infection in 17.1% (n = 7) and recurrent pulmonary infection or pulmonary embolism in 29.3% (n = 12). Fever was present in 95.1% of patients (n = 39), whereas blood cultures were positive in 65.9% (n = 27). Staphylococcus was the most prevalent pathogen in 59.3% (n = 16), Gram-negative bacteria in 25.9% (n = 7). Transoesophageal echocardiography showed intracardiac vegetations in 73.2% of patients (n = 30). Non-different pathogen types with the most common methicillin-sensitive Staphylococcus aureus 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 (n = 2). MDC versus MDLC indicated definite CDRIE in 48.8% versus 80.5%, respectively (p = 0.003).

Conclusions: 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 Staphylococci, Gram-negative bacteria accounted for a quarter of CDRIE. Modified Duke lead criteria proved superior to MDC.

Keywords: cardiac resynchronization therapy; endocarditis; heart failure; signs; symptoms.