title: Clinical predictors of cardiovascular implantable electronic device-related infective endocarditis.
abstract: BACKGROUND
  Cardiovascular implantable electronic device (CIED)-related infective endocarditis (CIED-IE) is a serious complication of cardiac device infection and is associated with increased mortality. At present, there exist no criteria to predict CIED-IE in patients who present with CIED infection.
  
  
  METHODS
  We retrospectively reviewed all cases of CIED infection seen at Mayo Clinic Rochester between 1991 and 2008. CIED-IE was classified using pathologic and clinical criteria. Clinical predictors of CIED-IE were identified using logistic regression, and quantified using a summary score and plotted against the distribution of CIED-IE.
  
  
  RESULTS
  Ninety-three (22.4%) of the 416 patients with CIED infection had CIED-IE. Host factors including chronic immunomodulator therapy exclusive of corticosteroid (odds ratio [OR], 3.79 [confidence interval (CI) 1.10, 13.04]), chronic corticosteroid therapy (OR, 2.15 [CI 0.93, 5.00]), hemodialysis (OR, 3.24 [CI 1.39, 7.55]), or remote infection (OR, 1.77 [CI 0.99, 3.14]) were associated with increased odds of CIED-IE. Patients with CIED-IE were at increased odds of presenting with fever (OR, 3.78 [CI 1.93, 7.40]), or malaise (OR, 1.87 [CI 1.02, 3.41]), and have findings of leukocytosis (OR, 3.61 [CI 1.51, 8.62]). In marked contrast, they were at decreased odds of exhibiting signs/symptoms of infection at the generator pocket site (OR, 0.19 [CI 0.10, 0.36]). Summary scores of 6 and 11 predicted CIED-IE in approximately 50% and 90% of cases, respectively.
  
  
  CONCLUSIONS
  Certain comorbid conditions and systemic manifestations of infection were associated with CIED-IE. In contrast, pocket site infection was negatively associated with CIED-IE. These findings should assist clinicians in identifying patients who would more likely benefit from further investigation of CIED-IE with transesophageal echocardiography.
authors.affiliation: Mayo School of Graduate Medical Education, Mayo Clinic, Rochester, Minnesota, USA. le.katherine1@mayo.edu
authors.forename: Katherine Y
authors.initials: KY
authors.lastname: LE
authors.forename: Muhammad R
authors.initials: MR
authors.lastname: Sohail
authors.forename: Paul A
authors.initials: PA
authors.lastname: Friedman
authors.forename: Daniel Z
authors.initials: DZ
authors.lastname: Uslan
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Cha
authors.forename: David L
authors.initials: DL
authors.lastname: Hayes
authors.forename: Walter R
authors.initials: WR
authors.lastname: Wilson
authors.forename: James M
authors.initials: JM
authors.lastname: Steckelberg
authors.forename: Larry M
authors.initials: LM
authors.lastname: Baddour
mesh_terms: D000368:Aged; D015897:Comorbidity; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D004696:Endocarditis / Q000175:diagnosis* / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008910:Minnesota / Q000453:epidemiology; D015995:Prevalence; D016016:Proportional Hazards Models; D016459:Prosthesis-Related Infections / Q000175:diagnosis* / Q000401:mortality*; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D015996:Survival Rate