Risk factors for cardiac implantable electronic device infection: a systematic review and meta-analysis

Polyzos, Konstantinos A.; Konstantelias, Athanasios A.; Falagas, Matthew E.

doi:10.1093/europace/euv053

Cited by 386 publications

(410 citation statements)

References 84 publications

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“…In our study, some risk factors for CDI were more common in patients with CDI versus those without; notably, kidney disease, having malignancies or being immunocompromised or taking oral anticoagulant drugs. This adds to an already extensive literature about risk factors for CDI [21].…”

Section: Discussionmentioning

confidence: 75%

Incidence and costs of cardiac device infections: retrospective analysis using German health claims data

et al. 2018

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Aim: Estimate incidence and costs of cardiac device infections (CDIs) in Germany. Materials & methods:Patients had an implantable cardioverter defibrillator implanted over 2010-2013 and were followed to December 2014 using German health insurance claims data. A case-controlled analysis was performed using propensity score matching methods. Results: Risk of CDI 12 months post-implant was 3.4% overall, either 2.9% for de novo procedures versus 4.4% for replacement procedures. Mean 3-year incremental expenditure per patient for patients with CDI compared with controls was €31,493 for de novo implant patients and €33,777 for replacement patients. Mean incremental expenditure was €59,419 per patient with a major infection. Conclusion: CDIs are highly expensive to manage, reinforcing the need for strategies to reduce their occurrence. [1]. These devices are recommended for selected patients in guidelines from specialty medical societies and health technology assessment agencies [2][3][4]. There is an extensive body of evidence that demonstrates benefits including prolonged survival, improved quality of life and cost-effectiveness.Implantation of cardiac devices carries a risk of adverse events. These are classifiable as access-related (e.g., pneumothorax, hemothorax and hematoma), lead-related (e.g., perforation, displacement, fracture and endocarditis), generator-related (e.g., generator failure, migration and erosion) and pocket infection. Complete removal of all hardware is recommended in medical society guidelines and other scientific documents for patients with established cardiac device-related infection (CDI), and this includes cases in which a localized pocket infection occurs in the absence of signs of systemic infection, due to high relapse rates observed with retained hardware [5][6][7]. On the other hand, cardiac implantable electronic device (CIED) removal is not required for superficial or incisional infection at the pocket site if there is no involvement of the device.A large randomized controlled trial (DANISH study) recently reported an infection rate of 4.9% in a cohort of 556 ICD/CRT-D patients over a median follow-up of 5.6 years [8]. Serious device infections occurred in 2.7% of patients, defined as requiring lead extraction or lifelong antibiotic treatment or causing death. Worryingly, the number of CDI cases has been increasing: national healthcare data for the USA reported the number of hospitalizations due to CDI rose from 5308 in the year 2003 to 9948 in 2011 [9]. The increase is attributed to multiple factors including increased use of CRT devices (which have three leads and a higher risk of infection),

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Section: Discussionmentioning

confidence: 75%

Incidence and costs of cardiac device infections: retrospective analysis using German health claims data

et al. 2018

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“…The role of these factors was documented previously. 1,4,14 As for the clinical fac tors, our study revealed a surprising finding about the protective effects of anticoagulation and an tiplatelet therapy. The fact that these protective effects were demonstrated in all the subgroups with CIED infections, including PI, is controver sial.…”

Section: Figurementioning

confidence: 66%

Infectious complications in patients with cardiac implantable electronic devices – risk factors, prevention and prognosis

Polewczyk¹,

Jacheć²,

Polewczyk³

et al. 2017

Polish Archives of Internal Medicine

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597has been rising due to an increasing number of ICD or CRT device implantations in a specif ic population of patients with severe heart fail ure (HF) and comorbidities. Furthermore, re cent years have witnessed a tremendous increase in average life expectancy, which translates into a higher number of reinterventions (generator re placement, system upgrade) in patients receiving CIEDs. 2-6 A significant increase in the incidence INTRODUCTION Cardiac implantable electron ic device (CIED) infections, which develop in pa tients with pacemakers, implantable cardiovert er-defibrillators (ICDs), and cardiac resynchro nization therapy (CRT) devices, pose a major clinical challenge. The incidence of these infec tions is estimated to range from 1% to 2% in pa tients with CIEDs.1 However, these data are inac curate because the incidence of CIED infections OBJECTIVES The aim of this study was to assess the risk factors and long term survival of patients with CIED infections. PATIENTS AND METHODSWe analyzed the clinical data of 1837 patients (including xx [40.9%] patients with CIED infections), who underwent transvenous lead extraction at a single institution between 2006 and 2015. We compared the clinical and procedure related factors for all types of CIED infections: iso lated pocket infection (IPI), isolated lead related infective endocarditis (ILRIE), and lead related infective endocarditis with coexisting pocket infection (LRIE + PI). We also analyzed long term survival rates. RESULTSThe development of IPI and LRIE + PI depended mainly on age, male sex, number of leads, presence of implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy defibrillator (CRT D), and the number of previous procedures. The factors that determined ILRIE included chronic renal failure (CRF), ICD/CRT D, lead loops, and intracardiac lead abrasion. Chronic anticoagulation and antiplatelet treatment protected against the development of infection. Long term survival was significantly related to age, heart failure, diabetes mellitus, CRF, malignancy, and chronic atrial fibrillation.CONCLUSIONS The development of all types of CIED infection was associated mainly with procedure related factors, while long term mortality was dependent on clinical factors. The dissimilarity of factors affecting the development of IPI and ILRIE confirms that there are 2 variants of CIED infection. The pro tective effects of chronic anticoagulation and antiplatelet treatment should prompt us to consider such therapy in the prevention of CIED infection.

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“…No additional data are provided about these two patients. There are various host-related and procedurerelated factors associated with CIED infections, including diabetes mellitus, chronic obstructive pulmonary disease, corticosteroid use, renal insufficiency, malignancy, heart failure, preprocedural fever, anticoagulant drug use, skin disorders, postoperative hematoma, and lack of antibiotic prophylaxis [6]. In light of this knowledge, it might be beneficial to know the baseline characteristics of these patients so as to avoid ICM infection.…”

Section: The Implantable Cardiac Monitor and Pocket Infectionmentioning

confidence: 99%

The implantable cardiac monitor and pocket infection

Uçar

2017

Herz

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Lauschke et al. [1] reported that a newly developed implantable cardiac monitor (ICM; BioMonitor) effectively detects patients with cardiac arrhythmia. In this prospective nonrandomized study, the BioMonitor provided safety results within the expected range. The implantation was successful in all 152 patients, and two device-related serious adverse events (pocket infections) occurred at 3 months.Cardiac implantable electronic devices (CIEDs) mainly include pacemakers, implantable cardiac defibrillators (ICDs), and cardiac resynchronization therapy (CRT) devices. ICMs can also be added to this list. Previous trials reported that the incidence of CIEDrelated infections ranges from 0 to 12.6% [2,3]. Pocket infections prolong hospital stay and increase medical costs. Moreover, the increased incidence of infectious complications is associated with substantially elevated morbidity and mortality rates [4,5]. In this study, devices were implanted epifascially in 42% of the patients and subcutaneously in 52%. Although ICM implantation is regarded a simple process, the infection range was 1.3%.In this well-presented article by Lauschke and colleagues, two devicerelated serious adverse events (pocket infections) occurred by 3 months in two patients and the devices were explanted. No additional data are provided about these two patients. There are various host-related and procedurerelated factors associated with CIED infections, including diabetes mellitus, chronic obstructive pulmonary disease, corticosteroid use, renal insufficiency, malignancy, heart failure, preprocedural fever, anticoagulant drug use, skin disorders, postoperative hematoma, and lack of antibiotic prophylaxis [6]. In light of this knowledge, it might be beneficial to know the baseline characteristics of these patients so as to avoid ICM infection.

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Risk factors for cardiac implantable electronic device infection: a systematic review and meta-analysis

Cited by 386 publications

References 84 publications

Incidence and costs of cardiac device infections: retrospective analysis using German health claims data

Incidence and costs of cardiac device infections: retrospective analysis using German health claims data

Infectious complications in patients with cardiac implantable electronic devices – risk factors, prevention and prognosis

The implantable cardiac monitor and pocket infection

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