Top

Journal of Interventional Cardiac Electrophysiology

Published in:

01-08-2011

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

Authors: Muhammad R. Sohail, Salwa Hussain, Katherine Y. Le, Chadi Dib, Christine M. Lohse, Paul A. Friedman, David L. Hayes, Daniel Z. Uslan, Walter R. Wilson, James M. Steckelberg, Larry M. Baddour, for the Mayo Cardiovascular Infections Study Group

Published in: Journal of Interventional Cardiac Electrophysiology | Issue 2/2011

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.

Sohail, M. R., Sultan, O. W., & Raza, S. S. (2010). Contemporary management of cardiovascular implantable electronic device infections. Expert Review of Anti-Infective Therapy, 8(7), 831–839.PubMedCrossRef

Epstein, A. E., Dimarco, J. P., Ellenbogen, K. A., et al. (2008). ACC/AHA/HRS 2008 Guidelines for device-based therapy of cardiac rhythm abnormalities. Heart Rhythm, 5(6), e1–62.PubMedCrossRef

Voigt, A., Shalaby, A., & Saba, S. (2006). Rising rates of cardiac rhythm management device infections in the United States: 1996 through 2003. Journal of the American College of Cardiology, 48(3), 590–591.PubMedCrossRef

Cabell, C. H., Heidenreich, P. A., Chu, V. H., et al. (2004). Increasing rates of cardiac device infections among Medicare beneficiaries: 1990–1999. American Heart Journal, 147(4), 582–586.PubMedCrossRef

Uslan, D. Z., Sohail, M. R., St Sauver, J. L., et al. (2007). Permanent pacemaker and implantable cardioverter defibrillator infection: A population-based study. Archives of Internal Medicine, 167(7), 669–675.PubMedCrossRef

Sohail, M. R., Uslan, D. Z., Khan, A. H., et al. (2007). Risk factor analysis of permanent pacemaker infection. Clinical Infectious Diseases, 45(2), 166–173.PubMedCrossRef

Klug, D., Balde, M., Pavin, 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.PubMedCrossRef

Mela, T., McGovern, B. A., Garan, H., et al. (2001). Long-term infection rates associated with the pectoral versus abdominal approach to cardioverter-defibrillator implants. The American Journal of Cardiology, 88(7), 750–753.PubMedCrossRef

Lekkerkerker, J. C., van Nieuwkoop, C., Trines, S. A., et al. (2009). Risk factors and time delay associated with cardiac device infections: Leiden device registry. Heart (British Cardiac Society), 95(9), 715–720.CrossRef

10.

Bloom, H., Heeke, B., Leon, A., et al. (2006). Renal insufficiency and the risk of infection from pacemaker or defibrillator surgery. Pacing and Clinical Electrophysiology, 29(2), 142–145.PubMedCrossRef

11.

Johansen, J. B., Nielsen, J. C., Arnsbo, P., Moller, M., Pedersen, A. K., & Mortensen, P. T. (2006). AB49-5: Higher incidence of pacemaker infection after replacement than after first implantation: Experiences from 36, 076 consecutive patients. Heart Rhythm, 3(5 Supplement 1), S102–S103.CrossRef

12.

Al-Khatib, S. M., Lucas, F. L., Jollis, J. G., Malenka, D. J., & Wennberg, D. E. (2005). The relation between patients' outcomes and the volume of cardioverter-defibrillator implantation procedures performed by physicians treating Medicare beneficiaries. Journal of the American College of Cardiology, 46(8), 1536–1540.PubMedCrossRef

13.

Sohail, M. R., Wilson, W. R., & Baddour, L. M. (2010). Infections of nonvalvular cardiovascular devices. In G. L. Mandell, J. E. Bennett, & R. Dolin (Eds.), Mandell, Douglas, and Bennett's principles and practice of infectious diseases, vol. I (pp. 1127–1142). Philadelphia: Churchill Livingstone.CrossRef

14.

Uslan, D. Z., Dowsley, T. F., Sohail, M. R., et al. (2010). Cardiovascular implantable electronic device infection in patients with Staphylococcus aureus bacteremia. Pacing and Clinical Electrophysiology, 33, 407–413.PubMedCrossRef

15.

Sohail, M. R., Uslan, D. Z., Khan, A. H., et al. (2007). Management and outcome of permanent pacemaker and implantable cardioverter-defibrillator infections. Journal of the American College of Cardiology, 49(18), 1851–1859.PubMedCrossRef

16.

Thal, S., Moukabary, T., Boyella, R., et al. (2010). The relationship between warfarin, aspirin, and clopidogrel continuation in the peri-procedural period and the incidence of hematoma formation after device implantation. Pacing and Clinical Electrophysiology, 33(4), 385–388.PubMedCrossRef

17.

de Bono, J., Nazir, S., Ruparelia, N., Bashir, Y., Betts, T., & Rajappan, K. (2010). Perioperative management of anticoagulation during device implantation—The UK perspective. Pacing and Clinical Electrophysiology, 33(4), 389–393.PubMedCrossRef

18.

Tolosana, J. M., Berne, P., Mont, L., et al. (2009). Preparation for pacemaker or implantable cardiac defibrillator implants in patients with high risk of thrombo-embolic events: Oral anticoagulation or bridging with intravenous heparin? A prospective randomized trial. European Heart Journal, 30(15), 1880–1884.PubMedCrossRef

19.

Jamula, E., Douketis, J. D., & Schulman, S. (2008). Perioperative anticoagulation in patients having implantation of a cardiac pacemaker or defibrillator: A systematic review and practical management guide. Journal of Thrombosis and Haemostasis, 6(10), 1615–1621.PubMedCrossRef

20.

Ahmed, I., Gertner, E., Nelson, W. B., et al. (2010). Continuing warfarin therapy is superior to interrupting warfarin with or without bridging anticoagulation therapy in patients undergoing pacemaker and defibrillator implantation. Heart Rhythm, 7(6), 745–749.PubMedCrossRef

21.

Cheng, M., Hua, W., Chen, K., et al. (2009). Perioperative anticoagulation for patients with mechanic heart valve(s) undertaking pacemaker implantation. Europace, 11(9), 1183–1187.PubMedCrossRef

22.

Daubert JC, Mabo P. Continue or withhold oral anticoagulation in high-risk patients undergoing pacemaker or ICD implantation. European heart journal. Aug 28 2009.

23.

Love, C. J. (2010). Perioperative management of anticoagulation in patients undergoing cardiac rhythm device procedures: A bridge to nowhere? Pacing and Clinical Electrophysiology, 33(4), 383–384.PubMedCrossRef

24.

Douketis, J. D., Berger, P. B., Dunn, A. S., et al. (2008). The perioperative management of antithrombotic therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest, 133(6 Suppl), 299S–339S.PubMedCrossRef

25.

H.K. Li, F.C. Chen and R.F. Rea et al., Safety of continuing warfarin in patients who undergo device-related procedure, Heart Rhythm 6 (Suppl 1) (2009), p. MP044.

26.

Trappe, H. J., Pfitzner, P., Klein, H., & Wenzlaff, P. (1995). Infections after cardioverter-defibrillator implantation: Observations in 335 patients over 10 years. British Heart Journal, 73(1), 20–24.PubMedCrossRef

27.

Lai, K. K., & Fontecchio, S. A. (1998). Infections associated with implantable cardioverter defibrillators placed transvenously and via thoracotomies: Epidemiology, infection control, and management. Clinical Infectious Diseases, 27(2), 265–269.PubMedCrossRef

28.

de Oliveira, J. C., Martinelli, M., Nishioka, S. A., et al. (2009). Efficacy of antibiotic prophylaxis before the implantation of pacemakers and cardioverter-defibrillators: Results of a large, prospective, randomized, double-blinded, placebo-controlled trial. Circulation: Arrhythmia and Electrophysiology, 2(1), 29–34.CrossRef

29.

Da Costa, A., Kirkorian, G., Cucherat, M., et al. (1998). Antibiotic prophylaxis for permanent pacemaker implantation: A meta-analysis. Circulation, 97(18), 1796–1801.PubMedCrossRef

30.

Sohail, M. R., Uslan, D. Z., Khan, A. H., et al. (2008). Infective endocarditis complicating permanent pacemaker and implantable cardioverter-defibrillator infection. Mayo Clinic Proceedings, 83(1), 46–53.PubMedCrossRef

31.

Borleffs, C. J. W., Thijssen, J., de Bie, M. K., et al. (2010). Recurrent implantable cardioverter-defibrillator replacement is associated with an increasing risk of pocket-related complications. Pacing and Clinical Electrophysiology, 33(8), 1013–1019.PubMed

Title: Risk factors associated with early- versus late-onset implantable cardioverter-defibrillator infections
Authors: Muhammad R. Sohail
Salwa Hussain
Katherine Y. Le
Chadi Dib
Christine M. Lohse
Paul A. Friedman
David L. Hayes
Daniel Z. Uslan
Walter R. Wilson
James M. Steckelberg
Larry M. Baddour
for the Mayo Cardiovascular Infections Study Group
Publication date: 01-08-2011
Publisher: Springer US
Published in: Journal of Interventional Cardiac Electrophysiology / Issue 2/2011
Print ISSN: 1383-875X
Electronic ISSN: 1572-8595
DOI: https://doi.org/10.1007/s10840-010-9537-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Aims

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Aims

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2011

“Near-zero” fluoroscopic exposure in supraventricular arrhythmia ablation using the EnSite NavX™ mapping system: personal experience and review of the literature

Electroanatomic localization of a slowly conducting atrioventricular (Mahaim) accessory pathway

Radiofrequency catheter ablation of ventricular tachycardia in arrhythmogenic right ventricular dysplasia/cardiomyopathy using non-contact electroanatomical mapping: single-center experience with follow-up up to median of 30 months

Rapid hemostasis at the femoral venous access site using a novel hemostatic pad containing kaolin after atrial fibrillation ablation

Comparison of PV signal quality using a novel circular mapping and ablation catheter versus a standard circular mapping catheter

Prediction of sudden cardiac death: next steps in pursuit of effective methodology