Clinical Predictors of Cardiovascular Implantable Electronic Device-Related Infective Endocarditis KATHERINE Y. LE, M.D.,* MUHAMMAD R. SOHAIL, M.D.,† PAUL A. FRIEDMAN, M.D.,‡ DANIEL Z. USLAN, M.D.,§ STEPHEN S. CHA,¶ DAVID L. HAYES, M.D.,‡ WALTER R. WILSON, M.D.,† JAMES M. STECKELBERG, M.D.,† LARRY M. BADDOUR, M.D.,† and for the Mayo Cardiovascular Infections Study Group From the *Mayo School of Graduate Medical Education, Mayo Clinic, Rochester, Minnesota; †Divisions of Infectious Diseases and ‡Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota; §Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, California; and ¶Division of Biostatistics and Informatics, Mayo Clinic, Rochester, Minnesota 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. (PACE 2011; 34:450–459) endocarditis, predictors, infection, pacemaker, defibrillator, cardiovascular implantable electronic device Disclosures: All < $10,000. PAF: Honoraria/Consultant: Medtronic, Guidant, Astra Zeneca. Sponsored research: Medtronic, Astra Zeneca via Beth Israel, Guidant, St. Jude, Bard. Intellectual property rights: Bard EP, Hewlett Packard, Medical Positioning, Inc. DZU: Research: American Heart Association. Honoraria/Consultant: Biotronik, Cubist, TyRx Pharma, Inc. DLH: Honoraria: Medtronic, Boston Scientific, St. Jude Medical, ELA Medical, Biotronik. Royalty payments: UpToDate; Wiley-Blackwell. Medical advisory board: Boston Scientific, St. Jude Medical, Pixel Velocity. Steering committee member: Medtronic, St. Jude Medical. LMB: Royalty payments: UpToDate. Editorship: Massachusetts Medical Society (Journal Watch Infectious Diseases); ACP/PIER editorial consultant. MRS: Honoraria/Consultant: TyRx Pharma, Inc. All other authors: No disclosures. Address for reprints: Katherine Y. Le, M.D., M.P.H., Mayo School of Graduate Medical Education, 200 First Street Introduction Implantation of cardiovascular implantable electronic devices (CIEDs), that include perma- nent pacemakers and implantable cardioverter- defibrillators, has rapidly increased in the United States over the past two decades. 1,2 According to one estimate, the implantation rate of CIEDs increased by 42% among Medicare beneficiaries from 1990 to 1999. 3 Unfortunately, increasing rates of CIED infection have also been observed, and are much higher than expected based on the implantation rates alone. 3,4 CIED infection can present as a pulse- generator pocket infection or as bloodstream SW, Rochester, MN 55905. Fax: 507-255-7767; e-mail: le.katherine1@mayo.edu Received July 19, 2010; revised October 12, 2010; accepted October 20, 2010. doi: 10.1111/j.1540-8159.2010.02991.x C 2010, The Authors. Journal compilation C 2010 Wiley Periodicals, Inc. 450 April 2011 PACE, Vol. 34