Permanent Pacemaker and Implantable Cardioverter Defibrillator Infections: Seven Years of Diagnostic and Therapeutic Experience of a Single Center

Abstract

Background: Increasing evidence-based indications for the implantation of permanent pacemakers (PMs) and implantable cardioverter defibrillators (ICDs) have led to an increase in the rate of device infections.The aim of the present study was to evaluate infection frequency, clinical characteristics, risk factors, and microbiologic and therapeutic features in patients with PM/ICD infections. Hypothesis: Clinical and demographic characteristics of the patients can affect the PM/ICD infections. Methods: The PM/ICD infection group consisted of 57 patients diagnosed and treated with PM/ICD infections in our hospital. The control group in this case-control study consisted of 833 patients in whom a PM or ICD had been implanted and no infections were noted. Results: Patients with PM/ICD infections (median age 65 years; range, 18-104 years) were older than those without PM/ICD infections (median age 58 years; range, 18-86 years; P = 0.005). The percentage of generator replacement was higher in the PM/ICD infection group compared with the control group (16% vs 8%, P = 0.003). Independent predictors of PM/ICD infections were advanced age (>60 years; odds ratio [OR]: 2.5, 95% confidence interval [CI]: 1.2-4.0, P = 0.021) and device revision (OR: 3.8, 95% CI: 1.5-5.5, P = 0.002). Primary antibiotic prophylaxis during the procedure reduced the risk for PM/ICD infection (OR: 0.5, 95% CI: 0.4-0.8, P = 0.011). Conclusions: PM/ICD infections occur in a significant number of patients. It is important to be aware of the risk factors for PM/ICD infections so that patients with an increased risk can be identified and preventive measures can be implemented.

Rates of and Factors Associated With Infection in 200 909 Medicare Implantable Cardioverter-Defibrillator Implants

“…Other studies that have used multivariable models have not included the c-statistic, so direct comparison of model strengths cannot be completed. 19,23,27,29,34,39,40 Regardless, even with a large number of patients and predictive variables, this study suggests that there are important unknown clinical and patient characteristics that influence ICD infection.…”

“…Warfarin use was associated with an increase risk, as seen in some previous studies, 20 though not all. 19,23,27 Warfarin may have increased the number of hematomas that did not require reintervention, which would not be counted as an adverse event in our study. Similar to previous studies, renal dysfunction, especially hemodialysis, was a potent risk factor in our study.…”

“…Several studies have demonstrated that a lead addition or generator change, including re-entering for manufacturer advisory, leads to a higher risk of infection compared with initial implantation. 7,19,20,23,[25][26][27][28][29][30] It is thought that bacteria can colonize a pocket after initial implantation but do not lead to clinical infection, as they are in equilibrium with the host immune response. 31 Disrupting the pocket with a redo procedure may affect the interaction between the organism and host, leading to a CIED infection.…”

Preventing cardiac implantable electronic device infections

“…All items should remain in their sterile containers until they are ready to be used in order to minimize the opportunity for bacterial colonization. Procedure duration is an important determinant of DRI 50,77 and the procedure should be performed as swiftly as the limits of safety will allow. A sub-pectoral implant should be considered if there is very little subcutaneous tissue as infection rate will be higher in these cases.…”

“…22,33,50 The most robust evidence supporting the use of antibiotic prophylaxis of DRI comes from a prospective double blind randomised placebo controlled trial conducted in 2009 by De Oliveira et al, in which patients undergoing CIED implantation were randomised to receive 1g of intravenous cefazolin immediately before the procedure. Pre procedural antibiotics successfully reduced the incidence of local pocket and procedure related systemic infection from 3.28% to 0.63% (p=0.016) leading to early trial discontinuation.…”