title: Lead vegetations in patients with local and systemic cardiac device infections: prevalence, risk factors, and therapeutic effects.
abstract: OBJECTIVE
  Actual rates of lead vegetations (LVs) in cardiovascular device infections (CDI) are debated in this study. The aim of this study is to characterize prevalence and risk factors of LV in patients with CDI treated with lead extraction (LE).
  
  
  RESULTS
  Between 2003 and 2011, 293 leads were extracted from 136 patients (age 70.5 ± 14.5 years, 109 male) with infective indications: 39.2% chronic draining sinus, 20.9% pocket infections, and 28.8% systemic infections/sepsis. All patients underwent transesophageal echocardiography (TEE) before LE. Lead vegetation prevalence was 40.4%: 62.2% in systemic infection, but noteworthy in local infection/chronic draining sinus (21.9/36.4%). Younger age, renal disease, ad dialysis were associated with systemic infection. Fever after last intervention, revision, previous reparative procedure, infection at wound/device site and infection >6 months were associated with local infection/chronic draining sinus. Cardiac resynchronization therapy device, fever after last intervention, infection <6 months, renal disease, dialysis, abnormal chest X-ray, fever at admission, pulmonary symptoms, white blood cell (WBC) count, erythrocyte sedimentation rate, C-reactive protein increase and positive blood samples were related to LV. Risk of vegetations was reduced by antibiotic prophylaxis. Multivariate analysis indicated that renal failure and increased WBC count were related to LV.
  
  
  CONCLUSIONS
  Lead vegetations were frequently observed in patients with only local symptoms. Therefore, TEE should be mandatory in all patients undergoing LE for infective indications.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Azienda Ospedaliero-Universitaria San Giovanni Battista di Torino, University of Turin, Molinette, Corso A. M. Dogliotti, 14 10126 Torino, Italy. pg.golzio@gmail.com
authors.forename: Pier Giorgio
authors.initials: PG
authors.lastname: Golzio
authors.forename: Anna Laura
authors.initials: AL
authors.lastname: Fanelli
authors.forename: Melissa
authors.initials: M
authors.lastname: Vinci
authors.forename: Elisa
authors.initials: E
authors.lastname: Pelissero
authors.forename: Mara
authors.initials: M
authors.lastname: Morello
authors.forename: Walter
authors.initials: W
authors.lastname: Grosso Marra
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Gaita
mesh_terms: D000368:Aged; D015897:Comorbidity; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D004567:Electrodes, Implanted / Q000706:statistics & numerical data*; D005260:Female; D006333:Heart Failure / Q000453:epidemiology* / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D007958:Leukocyte Count / Q000706:statistics & numerical data; D008297:Male; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D016459:Prosthesis-Related Infections / Q000453:epidemiology*; D051437:Renal Insufficiency / Q000453:epidemiology*; D012307:Risk Factors