Procalcitonin plasma level and microbiology in cardiovascular implantable electronic device infections

Purpose: To investigate the relationship between procalcitonin (PCT) plasma levels and microbiology in cardiovascular implantable electronic device (CIED) infections. Methods: Prospectively collected data on consecutive patients (pts) with CIED infection who underwent device and lead removal at our center in 2012 were reviewed for positive microbiological cultures obtained from ≥2 blood samples, infected pocket samples, explanted leads. Only pts with positive microbiological cultures and available PCT and CRP tests were included. Pts were divided into a low (<2.3 ng/ml) and high (≥2.3 ng/ml) PCT plasma level group. Results: Twenty-one of 58 pts (36%) who underwent removal of an infected CIED had positive microbiological cultures. Of these 21 pts (median age 71 [62 – 76], 85% male), 5 (24%) were identified in the high (median 23.22 [15.08-31.50]) and 16 (76%) in the low PCT plasma level group (median 0.11 [0.07-0.19]). Six (29%) pts had signs of local, 15 (71%) of a systemic infection. Lead vegetations and bloodstream infection was evident in all high PCT-group pts compared to 63% (P=ns) and 31% (P=0.012) in low PCT-group pts. High PCT-group pts had significantly higher CRP plasma levels (median 96 [68-191] vs. 15 [10-45] mg/dl, P=0.004) and tended to present longer intervals from last pocket intervention to extraction (median 19 [7-74] vs. 7 [3-23] months, P=ns). The graph depicts isolates according to the PCT plasma level. A high PCT yielded a specificity of 84% for infection with staphylococcus aureus. ![Figure][1] Graph 1 Conclusions: Elevated PCT plasma levels (≥2.3 ng/ml) seem to be associated with staphylococcus aureus-related systemic infections in pts with infected CIED. Conversely, low PCT plasma levels are related to less severe local or systemic infections mediated by staphylococcus epidermidis. [1]: pending:yes