Abstract 1661: Pacemaker Or Implantable Cardioverter-defibrillator Related Infection : Prospective Evaluation Of Diagnosis Criteria And Of An Algorithm Of Management.
We have prospectively evaluated algorithms of device-related infection (DRI) diagnosis and management.
Design: Between 1995 and 2004, 425 consecutive patients were referred for DRI suspicion. The Duke criteria for the diagnosis of endocarditis were used for the classification. Material removal was systematically proposed when the diagnosis of DRI was possible or in case of local complications (impending erosion, erosion or local infection). The choice of extraction technique, percutaneous versus surgical, was based on the presence and size of vegetations on transoesophageal echocardiography (TEE). All patients received intravenously antibiotics for 2 weeks after lead extraction, then orally for 4 weeks. DRI was confirmed based on positive bacteriological test from leads or infection resolution after material removal. The mean follow-up was 55 ± 31 months.
Results: DRI was rejected in 29 patients and classified as possible or definite in 396 pts. Local complications were the most frequent symptoms and 42.7%TEE disclosed vegetations. One third of the population was not classified with the Duke criteria and only one fifth was classified as definite infection. New criteria including local complications were added to the Duke criteria to classify the totality of our population with a new score. Score of ≥1 and >3 were sufficient for possible and definite infection definition respectively. Twenty-five (6.3 %) deaths were related to DRI with 14 procedure related deaths. Recurrence rate and infectious mortality was 43.5% and 13.0% without complete material removal. DRI recurred in 7/354 (1.9%) patients with complete material removal.
Conclusion: the mortality of DRI was high, DUKE criteria for the diagnosis of endocarditis were insufficient to diagnose DRI. The addition of new criteria allows a new score for the diagnosis of DRI. The reliability of the algorithm of DRI management was prospectively proved. Treatment requires complete removal of the implanted material.