Cardiac implantable electronic device infection in the cardiac referral center in Thailand: incidence, microbiology, risk factors, and outcomes

Abstract

BackgroundDespite the long experience of cardiac implantable electronic device (CIED) implantation in Thailand, epidemiology of CIED infection in Thailand has never been studied.MethodsA retrospective cohort study was conducted at the cardiac referral center in Thailand to investigate incidence of CIED infection and causative organisms between October 2002 and December 2017. A matched case‐control study was performed to determine the factors associated with CIED infection.ResultsIncidence of CIED infection was 0.9% with a stable trend during the studied period. There were 54 episodes of CIED infection. The median (interquartile range) age of the patients was 67.5 (53.0‐75.0) years. A total of 29 (53.7%), 18 (33.3%), and 7 (13.0%) were permanent pacemaker, automatic implantable cardioverter‐defibrillator, and cardio‐resynchronization therapy‐related infection, respectively. Gram‐positive cocci were the most common organism (24 episodes, 44.4%). Gram‐negative bacilli were isolated in six episodes (11.1%). About 9.3% were polymicrobial and 35.2% were culture negative. Multivariate analysis showed that previous CIED infection and generator revision procedure were associated with CIED infection (odds ratio [OR] 48.56, 95% confidence interval [CI] 3.72‐633.62; P = 0.003 and OR 19.99, 95% CI 1.28‐333.24; P = 0.033 respectively). Forty (74.1%) cases were cured. Leaving device in situ was the only factor significantly associated with poor outcome (OR 11.40, 95% CI 1.52‐85.73; P = 0.018).ConclusionsIn Thailand, while CIED implantation is rising, incidence of CIED infection is stable. Microbiology of CIED infection in Thailand is similar to western countries, albeit a higher proportion of negative culture. Previous CIED infection and generator revision procedure are associated with CIED infection.

Cardiovascular Implantable Electronic Device Infection and New Insights About Correlation Between Pro-inflammatory Markers and Heart Failure: A Systematic Literature Review and Meta-Analysis

“…The hypertension prevalence was particularly significant in two studies: 87.5% of 80 patients in Viola et al ( 36 ) and 87% among 350 patients in Rodriguez et al ( 28 ). We found a high hypertension prevalence in other studies: 68% of 22 patients in Refaat et al ( 27 ); 58% of 208 cases in Fukunaga et al ( 25 ); 52% among 151 cases in Rickard et al ( 29 ); 54% of 54 patients in Korkerdsup et al ( 26 ); and 52% among 107 patients in Nishii et al ( 39 ).…”

“…CIED complete removal and antimicrobial treatment was the most common chosen combination therapy in other studies: 91% of cases in a sample of 80 patients in Viola et al ( 36 ); 94% cases of 189 and 354 patients, respectively, in Sohail et al ( 19 ) and Esquer Garrigos et al ( 24 ); 96% cases among 145 patients in Greenspon et al ( 31 ); 90% of 416 patients in Le et al ( 21 ); and 81% of 54 patients in Korkerdsup et al ( 26 ).…”

“…The most common comorbidities consisted of cardiac diseases. The prevalence of HF was 46% of 10,242 cases analyzed in 12 articles: Viola et al ( 36 ) reported an HF prevalence of 76% (61 patients); it was 51% (96 cases) in Sohail et al ( 19 ); 41% (3,415 patients) in Aleong et al ( 33 ); 58% (207 patients) in Esquer Garrigos et al ( 24 ); 18% (37 patients) in Fukunaga et al ( 25 ); 26% (37 patients) in Greenspon et al ( 31 ); and 9% (5 patients) in Korkerdsup et al ( 26 ). Refaat et al ( 27 ) analyzed 22 patients with HF prevalence of 77%.…”

“…Heart rhythm disorder prevalence was 38% in a sample of 10,215 analyzed cases (10 articles). More than 50% of patients had this pathological condition in six articles: 85% (161 patients) in Sohail et al ( 19 ); 84% (350 patients) in Le et al ( 21 ); 74% (40 patients) in Korkerdsup et al ( 26 ); 64% (433 patients) in Al-Hijji et al ( 38 ); 63% (190 patients) in Döring et al ( 37 ); and 47% (71 patients) in Rickard et al ( 29 ).…”

“…CIED partial removal and antimicrobial treatment combination therapy was applied to 4% of patients in a sample of 884 patients in five studies ( 19 , 21 , 26 , 31 , 36 ).…”