P417 THE REBUS OF POCKET INFECTION

Abstract Introduction Guidelines define pocket infection as an infection limited exclusively to the generator pocket. This is clinically associated with local signs of inflammation. Often, however, the infection also involves leads which constitute an entrance door for cardiac and systemic infection. The pocket infection is a big puzzle for deciding the type of approach to adopt, conservative or aggressive? Our study aims to identify the significant predictive criteria to develop a score that identifies patients most at risk of endocarditis and sepsis. Materials and Methods 66 patients undergoing extraction for pocket infection were enrolled. Before extraction, all patients underwent instrumental and laboratory investigations to search for vegetation or culture positivity. Results Of the 66 patients, 61 presented vegetations and/or positive culture of the leads. The statistical analysis made it possible to assign a score to each sign and/or symptom (see table) with the creation of a score with a maximum cut–off of 5. The 61 positive patients had a score greater than/equal to 5. The score structured in this way demonstrated a predictive value of 92.4%, resulting positive in 61 out of 66 patients. Conclusion In patients with pocket infection, the identification of a highly predictive score of endocarditis or sepsis on leads allows the clinician to easily identify patients at higher risk to be rapidly referred to tertiary centers for the most suitable treatment of the clinical situation without having to carry out particular tests, often difficult to perform (PET/CT), and allows the electrophysiologist, who will have to carry out the extraction procedure, to have a precise indication in class I. The study we have started is a preliminary study which has the limit of the number of patients enrolled. We intend to increase the number of patients thanks to collaboration with other centers that carry out extractions. However, this study, based on the data obtained so far, could be a guide for the management of patients with pocket infection who often create embarrassment in decision–making on the therapy to be adopted, even due to the lack of clarity of the guidelines.