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Occult bacteraemia in cardiac implantable electronic device patients

a review of diagnostic workflow and mandatory therapy

Golzio, Pier Giorgioa; Magnano S. Lio, Massimoa; Bongiorni, Maria Graziab

Journal of Cardiovascular Medicine: May 2019 - Volume 20 - Issue 5 - p 271–277
doi: 10.2459/JCM.0000000000000754

Cardiac implantable electronic device (CIED) implantation has greatly increased, with an associated exponential increase in CIED infections (CDIs). Cardiac device related infective endocarditis (CDRIE) has high morbidity and mortality: approximately 10–21%. Therefore, a prompt diagnosis and radical treatment of CDRIE are needed; transvenous lead extraction (TLE) is the mainstay for the complete healing, even if associated with wide logistic problems, high therapeutic costs and high mortality risk for patients. Some criticisms about the value of Duke criteria and their limitations for the diagnosis of CDRIE are known. The significance of classic laboratory data, transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE), considered in the Duke score, are reviewed and critically discussed in this article, with regard to the specific field of the diagnosis of CDI. The need for new techniques for achieving the diagnostic reliability has been well perceived by physicians, and additional techniques have been introduced in the new European Society of Cardiology (ESC) and British Heart Rhythm Society (BHRS) guidelines on infective endocarditis. These suggested techniques, such as 18-Fluorodeoxyglucose PET/computed tomography (FDG-PET/CT), white blood cell PET (WBC PET) and lung multislice CT (MSCT), are also discussed in the study. This short review is intended as an extensive summary of the diagnostic workflow in cases of CDI and will be useful for readers who want to know more about this issue.

aDivision of Cardiology, Department of Internal Medicine, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino and University of Turin, Turin

bSecond Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy

Correspondence to Pier Giorgio Golzio, Division of Cardiology, Department of Internal Medicine, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Corso A. M. Dogliotti, 14 - 10126 Turin, Italy Tel: +390116636165; 393332274241; fax: +390116967053; e-mail:;;

Received 21 October, 2018

Revised 27 November, 2018

Accepted 8 December, 2018

© 2019 Italian Federation of Cardiology. All rights reserved.