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Risk factors associated with early- versus late-onset implantable cardioverter-defibrillator infections

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

An Erratum to this article was published on 19 October 2012

Abstract

Aims

The infection rates of implantable cardioverter-defibrillators systems (ICDs) are higher than that of permanent pacemaker. Risk factors associated with ICD infection have not been characterized and are the subject of the current investigation.

Methods

All patients who had an ICD implanted at Mayo Clinic Rochester between 1991 and 2008 were retrospectively reviewed. Each case of ICD infection was matched with two non-infected controls. Cases of ICD infection were further stratified by early- (≤6 months) versus late-onset (>6 months) infection. Multivariable analysis was performed to identify significant risk factors for ICD infection.

Results

Sixty-eight patients with ICD infection and 136 matched controls met the inclusion criteria. Thirty-five cases presented with early-onset infection and 33 had late-onset device infection. Staphylococcal species were the most common pathogens in both groups of patients. Patients with early-onset infection were more likely to present with generator pocket infection (p = 0.02). Patients with multiple comorbid conditions (high Charlson index) tended to have longer hospital stay during implantation admission (p = 0.009). In a multivariable logistic regression model, the presence of epicardial leads (odds ratio (OR) = 9.7, p = 0.03) and postoperative complications at the generator pocket (OR = 27.2, p < 0.001) were significant risk factors for early-onset ICD infection, whereas longer duration of hospitalization at the time of implantation (2 days versus 1 day: OR = 33.1, p < 0.001; ≥3 days versus 1 day: OR = 49.0, p < 0.001) and chronic obstructive pulmonary disease (OR = 9.8, p = 0.02) were associated with late-onset infections.

Conclusions

Our study findings suggest that risk factors associated with early- and late-onset ICD infection are different. While circumstances that may increase the chances of pocket contamination in the perioperative period are more likely to be associated with early-onset ICD infection, overall poor health of the host may increase the likelihood of late-onset ICD infection. These factors should be considered when developing strategies to minimize risk of device infection.

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Abbreviations

BSI:

Blood stream infection

CIED:

Cardiovascular implantable electronic device

EP:

Electrophysiologic

ICD:

Implantable cardioverter-defibrillator

PPM:

Permanent pacemaker

TEE:

Transesophageal echocardiogram

TTE:

Transthoracic echocardiogram

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Acknowledgments

This investigation utilized resources of the Mayo Cardiovascular Infections Study Group (Le KY, Sohail MR, Baddour LM, Steckelberg JM, Wilson WR, Enzler MJ, Knoll BM, Raza SS, Chung HH, Friedman PA, Hayes DL, Anavekar NS, Nkomo VT, Dib C, Madhavan M, Sultan OW, Correa de Sa DD, Bachuwar A, Abou Ezzeddine OF, Habib A, Patel R, Williamson EE, Kalra M, Edwards WD, Maleszewski JJ [Mayo Clinic Rochester]; Hellinger WC, Lynady CJ, Kusumoto F [Mayo Clinic Florida]; Virkram HR and Keckich DW [Mayo Clinic Arizona]). We wish to thank Joanne E. Spencer for her important contribution in data collection. This study was supported by a Career Development Award to Dr. Sohail by the Department of Medicine, Mayo Foundation for Medical Education and Research.

Financial 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.

DLH:

  • Honoraria: Medtronic, Boston Scientific, St. Jude Medical, Sorin Medical, Biotronik

  • Sponsored research: Medtronic, Guidant, St. Jude Medical

  • Medical advisory board: Boston Scientific, St. Jude Medical, Medtronic

  • Steering committee member: Medtronic, St. Jude Medical

LMB:

  • Honoraria/Consultant: Massachusetts Medical Society <$20,000.

  • Royalty payments: UpToDate

  • Editorship: Massachusetts Medical Society (Journal Watch Infectious Diseases); ACP/PIER editorial consultant

MRS:

  • Honoraria/Consultant: TyRx Pharma, Inc.

DZU:

  • Honoraria/Consulting: BioTronik and Medtronik

Remaining authors:

No disclosures.

Conflicts of interest

None for all authors.

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Correspondence to Muhammad R. Sohail.

Additional information

An erratum to this article can be found online at http://10.1007/s10840-012-9730-1.

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Sohail, M.R., Hussain, S., Le, K.Y. et al. Risk factors associated with early- versus late-onset implantable cardioverter-defibrillator infections. J Interv Card Electrophysiol 31, 171–183 (2011). https://doi.org/10.1007/s10840-010-9537-x

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  • DOI: https://doi.org/10.1007/s10840-010-9537-x

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