Lead vegetations in patients with local and systemic cardiac device infections: prevalence, risk factors, and therapeutic effects

Golzio, P. G.; Fanelli, Antonella; Vinci, Melissa; Pelissero, E.; Morello, Mara; Marra, Walter Grosso; Gaïta, Fiorenzo

doi:10.1093/europace/eus240

Cited by 36 publications

(34 citation statements)

References 46 publications

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“…The multivariate analysis demonstrated a significant relationship between elevated CRP and LDIE. In one of the few studies measuring inflammatory markers in LDIE, the ESR, CRP, and white blood cell count were elevated [25]. Another analysis of 44 patients with LDIE confirmed the significantly elevated ESR and white blood cell count in over 50 % of patients [13].…”

Section: Discussionmentioning

confidence: 95%

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Clinical manifestations of lead-dependent infective endocarditis: analysis of 414 cases

Polewczyk

Janion

Podlaski

et al. 2014

Eur J Clin Microbiol Infect Dis

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It is important to identify clinical manifestations of lead-dependent infective endocarditis (LDIE), as it begins insidiously with the slow development of nonspecific symptoms. Clinical data from 414 patients with the diagnosis of LDIE according to Modified Duke Lead Criteria (MDLC) were analyzed. Patients with LDIE had been identified in a population of 1,426 subjects submitted to transvenous lead extraction (TLE) in the Reference Clinical Cardiology Center in Lublin between 2006 and 2013. The symptoms of LDIE and pocket infection were detected in 62.1 % of patients. The mean duration of LDIE symptoms prior to referral for TLE was 6.7 months. Fever and shivers were found in 55.3 % of patients, and pulmonary infections in 24.9 %. Vegetations were detected in 67.6 % of patients, and positive cultures of blood, lead, and pocket in 34.5, 46.4, and 30.0 %, respectively. The most common pathogens in all type cultures were coagulase-negative staphylococci (CNS), with Staphylococcus epidermidis domination; the second most common organism was Staphylococcus aureus. 76.3 % of patients were treated with empirical antibiotic therapy before hospitalization due to TLE. In the laboratory tests, the mean white blood cell count was 9,671 ± 5,212/μl, mean erythrocyte sedimentation rate 43 mm, C-reactive protein (CRP) 46.3 mg/dl ± 61, and procalcitonin 1.57 ± 4.4 ng/ml. The multivariate analysis showed that the probability of LDIE increased with increasing CRP. The diagnosis of LDIE based on MDLC may be challenging because of a relatively low sensitivity of major criteria, which is associated with early antibiotic therapy and low usefulness of minor criteria. The important clinical symptoms of LDIE include fever with shivering and recurrent pulmonary infections. The most specific pathogens were Staphylococcus epidermidis and Staphylococcus aureus. Laboratory tests most frequently revealed normal white blood cell count, relatively rarely elevated procalcitonin level, and significantly increased erythrocyte sedimentation rate (ESR) and CRP. This constellation of signs should prompt a more thorough search for LDIE.

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Section: Discussionmentioning

confidence: 95%

“…TEE in the present study detected vegetations in 60.0 % of patients. A recent observational study in 136 patients undergoing TLE for infective reasons demonstrated a similar location and frequency of vegetations in TEE [25]. …”

Section: Discussionmentioning

confidence: 99%

Clinical manifestations of lead-dependent infective endocarditis: analysis of 414 cases

Polewczyk

Janion

Podlaski

et al. 2014

Eur J Clin Microbiol Infect Dis

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“…Kilka czynników prognostycznych można dokładniej ocenić na podstawie TTE niż TEE, w tym obecność płynu w worku osierdziowym, zaburzenia funkcji komór i wartości ciśnień w krążeniu płucnym. TEE cechuje się większą czułością i specyficznością w odniesieniu do rozpoznania zapalenia wsierdzia związanego z elektrodami [381][382][383][384][385]. TEE pozwala zobrazować elektrody o nietypowej lokalizacji, np.…”

Section: Rozpoznanieunclassified

2015 ESC Guidelines for the management of infective endocarditis

Habib¹,

Lancellotti

Antunes³

et al. 2015

Kardiol Pol

148

212

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“…However, some studies have reported the prevalence of lead vegetation to be as high as 40%. 8,9 In addition, the risk of infection can increase up to tenfold if the patient is undergoing a lead replacement or a device upgrade. 10 Early infection refers to cases occurring the first month following the procedure.…”

Section: Epidemiologymentioning

confidence: 99%

<div>Review of cardiac implantable electronic device related infection</div>

Saliba¹,

Massie²,

Sia³

2016

RRCC

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Cardiac implantable electronic devices (CIEDs) are being used more and more often nowadays. Indications have grown, and access to implantation facilities has increased as well. These devices are often lifesaving, and they can be associated with many other benefits. However, as with any medical procedure, complications can occur. In fact, CIED infection is a prevalent complication that can cause high morbidity and can even lead to death. It is important that most clinicians be familiar with signs and symptoms associated with CIED infection as early diagnosis and treatment lead to better outcomes. Nonetheless, the prevention of such infections remains the cornerstone in the management of CIED-related infections. In this paper, we will review in detail the most significant risk factors that can lead to CIED infection. We will also explore the different available tools that can help decrease the incidence of this complication. In addition, we will summarize the different treatment modalities and the major prevention methods.

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Lead vegetations in patients with local and systemic cardiac device infections: prevalence, risk factors, and therapeutic effects

Abstract: Lead vegetations were frequently observed in patients with only local symptoms. Therefore, TEE should be mandatory in all patients undergoing LE for infective indications.

Cited by 36 publications

References 46 publications

Clinical manifestations of lead-dependent infective endocarditis: analysis of 414 cases

Clinical manifestations of lead-dependent infective endocarditis: analysis of 414 cases

2015 ESC Guidelines for the management of infective endocarditis

<div>Review of cardiac implantable electronic device related infection</div>

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