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Implantable electrophysiologic cardiac device infections: a risk factor analysis

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Abstract

The risk of cardiac device infection (CDI) is rising significantly, with several risk factors identified. The purpose of this study is to determine the rate of CDI at our center and to assess the associated risk factors, in order to define appropriate measures to prevent this complication. We retrospectively reviewed all cases of patients with CDI at St. George Hospital between February 1999 and July 2010. Each case was matched with three controls. We performed a descriptive and bivariate analysis to identify significant risk factors. Eighteen case patients and 54 control subjects met the inclusion criteria. An organism was recovered in 58 % of the cases. Significant risk factors included previous history of CDI (p < 0.001), recent manipulation (p < 0.001), trauma to the site of implant (p = 0.003), having a dual chamber/dual lead pacemaker (p = 0.002), and development of post-procedural hematoma (p = 0.012). Our findings complement the results of previous studies. We recommend a pre-procedural risk assessment and a thorough post-implantation follow-up to prevent the development of infective complications.

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References

  1. Bloom H et al (2006) Renal insufficiency and the risk of infection from pacemaker or defibrillator surgery. Pacing Clin Electrophysiol 29(2):142–145

    Article  PubMed  Google Scholar 

  2. Epstein AE et al (2008) ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. J Am Coll Cardiol 51(21):e1–e62

    Article  PubMed  Google Scholar 

  3. Chua JD et al (2000) Diagnosis and management of infections involving implantable electrophysiologic cardiac devices. Ann Intern Med 133(8):604–608

    PubMed  CAS  Google Scholar 

  4. Sohail MR et al (2011) Mortality and cost associated with cardiovascular implantable electronic device infections. Arch Intern Med 171(20):1821–1828

    Article  PubMed  Google Scholar 

  5. Uslan DZ et al (2007) Permanent pacemaker and implantable cardioverter defibrillator infection: a population-based study. Arch Intern Med 167(7):669–675

    Article  PubMed  Google Scholar 

  6. Lai KK, Fontecchio SA (1998) Infections associated with implantable cardioverter defibrillators placed transvenously and via thoracotomies: epidemiology, infection control, and management. Clin Infect Dis 27(2):265–269

    Article  PubMed  CAS  Google Scholar 

  7. Voigt A, Shalaby A, Saba S (2010) Continued rise in rates of cardiovascular implantable electronic device infections in the United States: temporal trends and causative insights. Pacing Clin Electrophysiol 33(4):414–419

    Article  PubMed  Google Scholar 

  8. Sohail MR et al (2007) Risk factor analysis of permanent pacemaker infection. Clin Infect Dis 45(2):166–173

    Article  PubMed  Google Scholar 

  9. Johansen JB et al (2011) Infection after pacemaker implantation: infection rates and risk factors associated with infection in a population-based cohort study of 46299 consecutive patients. Eur Heart J 32(8):991–998

    Article  PubMed  Google Scholar 

  10. Baddour LM et al (2003) Nonvalvular cardiovascular device-related infections. Circulation 108(16):2015–2031

    Article  PubMed  Google Scholar 

  11. Durack DT, Lukes AS, Bright DK (1994) New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. Am J Med 96(3):200–209

    Article  PubMed  CAS  Google Scholar 

  12. Wiegand UK et al (2004) Pocket hematoma after pacemaker or implantable cardioverter defibrillator surgery: influence of patient morbidity, operation strategy, and perioperative antiplatelet/anticoagulation therapy. Chest 126(4):1177–1186

    Article  PubMed  Google Scholar 

  13. Klug D et al (2007) Risk factors related to infections of implanted pacemakers and cardioverter-defibrillators: results of a large prospective study. Circulation 116(12):1349–1355

    Article  PubMed  Google Scholar 

  14. Takahashi T et al (2002) High incidence of device-related and lead-related complications in the dual-chamber implantable cardioverter defibrillator compared with the single-chamber version. Circ J 66(8):746–750

    Article  PubMed  Google Scholar 

  15. Kutinsky IB et al (2010) Risk of hematoma complications after device implant in the clopidogrel era. Circ Arrhythm Electrophysiol 3(4):312–318

    Article  PubMed  Google Scholar 

  16. Costea A et al (2008) Complications associated with generator replacement in response to device advisories. J Cardiovasc Electrophysiol 19(3):266–269

    Article  PubMed  Google Scholar 

  17. Gould PA, Krahn AD (2006) Complications associated with implantable cardioverter-defibrillator replacement in response to device advisories. JAMA 295(16):1907

    Article  PubMed  CAS  Google Scholar 

  18. Kapa S et al (2007) Complication risk with pulse generator change: implications when reacting to a device advisory or recall. Pacing Clin Electrophysiol 30(6):730–733

    Article  PubMed  Google Scholar 

  19. Curtis AB, Ellenbogen KA, Hammill SC, Hayes DL, Reynolds DW, Wilber DJ, Cain ME (2004) Heart Rhythm Society Clinical competency statement: training pathways for implantation of cardioverter defibrillators and cardiac resynchronization devices. Heart Rhythm 1(3):371–375

    Article  PubMed  Google Scholar 

  20. Chauhan A et al (1994) Early complications after dual chamber versus single chamber pacemaker implantation. Pacing Clin Electrophysiol 17(11):2012–2015

    Article  PubMed  CAS  Google Scholar 

  21. Nery PB et al (2010) Device–related infection among patients with pacemakers and implantable defibrillators: incidence, risk factors, and consequences. J Cardiovasc Electrophysiol 21(7):786–790

    PubMed  Google Scholar 

  22. Margey R et al (2010) Contemporary management of and outcomes from cardiac device related infections. Europace 12(1):64

    Article  PubMed  Google Scholar 

  23. Howarth DM, Curteis PG, Gibson S (1998) Infected cardiac pacemaker wires demonstrated by Tc-99 m labeled white blood cell scintigraphy. Clin Nucl Med 23(2):74

    Article  PubMed  CAS  Google Scholar 

  24. Dasgupta A et al (2007) Increased complication rates of cardiac rhythm management devices in ESRD patients. Am J Kidney Dis 49(5):656–663

    Article  PubMed  Google Scholar 

  25. Greenspon AJ et al (2011) 16-year trends in the infection burden for pacemakers and implantable cardioverter-defibrillators in the United States: 1993 to 2008. J Am Coll Cardiol 58(10):1001–1006

    Article  PubMed  Google Scholar 

  26. Le KY et al (2011) Clinical predictors of cardiovascular implantable electronic device–related infective endocarditis. Pacing Clin Electrophysiol 34(4):450–459

    Article  PubMed  Google Scholar 

  27. Parsonnet V, Bernstein AD, Lindsay B (1989) Pacemaker-implantation complication rates: an analysis of some contributing factors. J Am Coll Cardiol 13(4):917–921

    Article  PubMed  CAS  Google Scholar 

  28. Al-Khatib SM et al (2005) The relation between patients’ outcomes and the volume of cardioverter-defibrillator implantation procedures performed by physicians treating Medicare beneficiaries. J Am Coll Cardiol 46(8):1536–1540

    Article  PubMed  Google Scholar 

  29. Remmelts HH et al (2009) Infection after ICD implantation: operating room versus cardiac catheterisation laboratory. Neth Heart J 17(3):95–100

    Article  PubMed  CAS  Google Scholar 

  30. Glieca F et al (1987) The role of antibiotic prophylaxis in the implantation of pacemakers. Minerva Cardioangiol 35(10):549–552

    PubMed  CAS  Google Scholar 

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Acknowledgments

We would like to thank Dr. Brian Page for his help in formatting the tables, and Dr. Elie Akl for his help in revising the manuscript.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Medicine, State University of New York at Buffalo, Buffalo, NY, USA

    D. Raad

  2. Department of Medicine, Faculty of Medicine and Medical Sciences, University of Balamand, Beirut, Lebanon

    J. Irani

  3. Department of Medicine, Mount Sinai School of Medicine (Englewood Hospital program), Englewood, NJ, USA

    E. G. Akl

  4. Department of Medicine, Division of Cardiology, Faculty of Medicine and Medical Sciences, University of Balamand, Beirut, Lebanon

    S. Choueiri & J. Abboud

  5. Department of Medicine, Division of Infectious Diseases, Faculty of Medicine and Medical Sciences, University of Balamand, Beirut, Lebanon

    E. Azar & C. Afif

  6. Department of Medicine, Division of Infectious Diseases, Saint George Hospital University Medical Center, University of Balamand, St George Hospital, Ashrafieh, PO Box 166378, Beirut, Lebanon

    C. Afif

Authors
  1. D. Raad
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  2. J. Irani
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  3. E. G. Akl
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  4. S. Choueiri
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  5. E. Azar
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  6. J. Abboud
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  7. C. Afif
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Correspondence to C. Afif.

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Raad, D., Irani, J., Akl, E.G. et al. Implantable electrophysiologic cardiac device infections: a risk factor analysis. Eur J Clin Microbiol Infect Dis 31, 3015–3021 (2012). https://doi.org/10.1007/s10096-012-1655-1

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  • DOI: https://doi.org/10.1007/s10096-012-1655-1

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