Infections and associated costs following cardiovascular implantable electronic device implantations: a nationwide cohort study

Clémenty, Nicolas; Carion, Phuong Lien; Léotoing, Lucie de; Lamarsalle, L.; Wilquin-Bequet, Fanny; Brown, Breanna; Verhees, Koen J P; Fernandes, Jérôme; Deharo, Jean‐Claude

doi:10.1093/europace/eux387

Cited by 79 publications

(70 citation statements)

References 20 publications

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“…The average hospital length of stay for patients with pacemaker‐related infections ranges from 15.5 to 24 days . The cost associated with such admissions is significant, exceeding $28 000 in the U.S. and €23 000 in France . More importantly, the 1‐year mortality after pacemaker infections can exceed 35% .…”

Section: Introductionmentioning

confidence: 99%

“…Other authors: No disclosures. length of hospitalization following Micra implant was 2 days (IQR, [1][2][3][4][5][6][7]. During followup, two patients died from sepsis and four patients required system upgrade, of which two patients received Micra to provide temporary pacing support.…”

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confidence: 99%

“…CIED infections are associated with a significant increase in hospital length of stay, cost, and mortality. [3][4][5] The average hospital length of stay for patients with pacemaker-related infections ranges from 15.5 to 24 days. 3 The cost associated with such admissions is significant, exceeding $28 000 in the U.S. and €23 000 in France.…”

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confidence: 99%

“…3 The cost associated with such admissions is significant, exceeding $28 000 in the U.S. and €23 000 in France. 4 More importantly, the 1-year mortality after pacemaker infections can exceed 35%. 3,5 Furthermore, the risk of reinfection after reimplantation is around 2% and exceeds 11% in patients who had only partial removal of the original device.…”

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confidence: 99%

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Leadless pacemaker implant in patients with pre‐existing infections: Results from the Micra postapproval registry

El‐Chami

Johansen

Zaidi

et al. 2019

Cardiovasc electrophysiol

114

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IntroductionLeadless pacemakers may provide a safe and attractive pacing option to patients with cardiac implantable electronic device (CIED) infection. We describe the characteristics and outcomes of patients with a recent CIED infection undergoing Micra implant attempt.Methods and ResultsPatients with prior CIED infection and device explant with Micra implant within 30 days, were identified from the Micra post approval registry. Procedure characteristics and outcomes were summarized. A total of 105 patients with prior CIED infection underwent Micra implant attempt ≤30 days from prior system explant (84 [80%] pacemakers and 13 [12%] ICD/CRT‐D). All system components were explanted in 93% of patients and explant occurred a median of 6 days before Micra implant, with 37% occurring on the day of Micra implant. Micra was successfully implanted in 99% patients, mean follow‐up duration was 8.5 ± 7.1 months (range 0‐28.5). The majority of patients (91%) received IV antibiotics preimplant, while 42% of patients received IV antibiotics postprocedure. The median length of hospitalization following Micra implant was 2 days (IQR, 1‐7). During follow‐up, two patients died from sepsis and four patients required system upgrade, of which two patients received Micra to provide temporary pacing support. There were no Micra devices explanted due to infection.ConclusionImplantation of the Micra transcatheter pacemaker is safe and feasible in patients with a recent CIED infection. No recurrent infections that required Micra device removal were seen. Leadless pacemakers appear to be a safe pacing alternative for patients with CIED infection who undergo extraction.

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Section: Introductionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Leadless pacemaker implant in patients with pre‐existing infections: Results from the Micra postapproval registry

El‐Chami

Johansen

Zaidi

et al. 2019

Cardiovasc electrophysiol

114

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“…Pocket infection is prevalent among CIED infections (up to 69% of cases), mostly due to staphylococci species, and prompts clinical efforts to prevent SSI . On the basis of current clinical knowledge, CIED infections range from 1% to 4% being highest at replacements and upgrades (defined as addition of one or more lead/s) and according to specific patient profiles . Pocket seeding by bacteria at the time of CIED surgery is the main mechanism of SSI; biofilm formation on the CIED/lead surface and at nonvascularized pocket tissue is the mechanism of escape to antibiotic activity, and of infection spreading to the circulation and to distant sites .…”

Section: Introductionmentioning

confidence: 99%

The never‐ending story of CIED infection prevention: Shall we WRAP‐IT and go?

Biffi

2019

Cardiovasc electrophysiol

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CIED infection is perceived as substantial, ranging from 1% to 4% in literature depending on different studies and on the population profile, and can appear either as surgical site or endovascular infection or both. Several factors have been found to be associated to CIED infection, that can be summarized as patient-related (clinical profile, associated comorbidities, ongoing treatment as anticoagulants and immunosuppressants), Procedure-related (complexity of CIED surgery, type of surgery, previous pocket exploration), and center-/operator-related (center/operator volume). Thus, it is difficult to disentangle the extent of benefit that any intervention may offer to decrease this threatened complication, owing to its multifaceted complexity. The recently completed PADIT and WRAP-IT trials have significantly improved our knowledge in this field (nearly 20 000 patients enrolled), reporting an infection rate of 1% to 1.2% in control-arm patients and a 20% to 67% infection decrease when incremental antibiotic prophylaxis is added on top of optimized preventative strategies. Observational registries highlighted that participation in a prospective survey of CIED infection dramatically decrease infection rate by optimization of antisepsis protocols and operator awareness, that explains the low event rate observed in PADIT and WRAP-IT. While this consideration prompts each center to engage into a proactive infection prevention program, it makes a point in favor of antibiotic prophylaxis delivered locally in 7 days or more, as enabled by TYRX in the WRAP-IT trial. However, care sustainability (the number needed to treat in the most favorable WRAP-IT scenario is 100) suggests further analysis to understand the settings (patient-or procedure-related) most likely to benefit by such an enhanced prevention strategy. K E Y W O R D Santibiotic prophylaxis, CIED infection, prevention

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Time to rechallenge primary prevention ICD guidelines

2022

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Infections and associated costs following cardiovascular implantable electronic device implantations: a nationwide cohort study

Abstract: Cardiac device infections in France are associated with substantial costs, when considering inpatient hospitalizations. Strategies to minimize the rate of CIED infection should be a priority for health care providers and payers.

Cited by 79 publications

References 20 publications

Leadless pacemaker implant in patients with pre‐existing infections: Results from the Micra postapproval registry

Leadless pacemaker implant in patients with pre‐existing infections: Results from the Micra postapproval registry

The never‐ending story of CIED infection prevention: Shall we WRAP‐IT and go?

Time to rechallenge primary prevention ICD guidelines

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