New Insights into Predictors of Cardiac Implantable Electronic Device Infection

Abstract

Infection is an important complication of cardiac implantable electronic device procedures. To further study the factors associated with infection, we retrospectively reviewed the records of 3,205 consecutive patients who had undergone de novo or revision cardiac electronic device implantation at our institution from March 2011 through March 2015. We recorded all infections and specified whether they were related to the characteristics of the patient, device, or procedure. To identify predictors of infection, we performed multivariate analysis. Device infections were identified in 85 patients (2.7%), at a mean follow-up time of 27 ± 11 months. The main predictors of device infection were use of an implantable cardioverter-defibrillator or a cardiac resynchronization therapy defibrillator device (odds ratio [OR]=16; 95% CI, 4.14-61.85; =0.0001), stage 3 chronic kidney disease (OR=9.41; 95% CI, 1.77-50.04;=0.009), a revision procedure (OR=8.8; 95% CI, 3.37-23.2; =0.0001), or postoperative hematoma (OR=6.9; 95% CI, 1.58-30.2;=0.01). We also identified 2 novel predictors of infection: a low body mass index of <20 kg/m (OR=1.03; 95% CI, 1.01-1.06; =0.005), and use of povidone-iodine rather than chlorhexidine-alcohol for topical antisepsis (OR=4.4; 95% CI, 2.01-9.4;=0.03). We conclude that comorbidities, device characteristics, procedure types, and postoperative noninfective complications all increase the risk of device infection after a cardiac implantable electronic device procedure.

Strategies to Prevent Cardiac Implantable Electronic Device Infection

“…In one study, the presence of a postoperative hematoma was associated with an almost sevenfold increase in the rate of CIED infection. 37 This finding supports the observed correlation between anticoagulant use and increased CIED infection risk. Multiple studies have revealed that the need for temporary pacing, device revisions, and increased procedural duration significantly increase the rate of CIED infections.…”

“…Given the association between postprocedural hematoma formation and the increased risk of CIED infection, 37 strategies to prevent postoperative hematomas have been recommended, which include the placement of pressure dressings, the scrupulous use of electrocauterization, and the administration of hemostatic agents. 56 Some of the hemostatic agents studied include microporous polysaccharide hemostatic (MPH) powder (Arista; Bard, Warwick, RI, USA), oxidized regenerated cellulose (Surgicel Fibrillar Hemostat; Johnson & Johnson, New Brunswick, NJ, USA), local tranexemic acid (TXA), and topical thrombin.…”

Antibiotic envelope is associated with reduction in cardiac implantable electronic devices infections especially for high‐power device—Systematic review and meta‐analysis

“…Hence, these factors were the consideration for performing subgroup analysis on device type; unfortunately, we were unable to perform analysis in ICD, CRT, and PPM individually because of the lack of data; we can only perform a meta‐analysis for high‐power vs low‐power device. Implantation of ICD or CRT‐D (high‐power device) was shown to be an independent predictor of CIED infection which is possibly because of the more prolonged procedure, multiple leads, higher incidence of early re‐intervention for LV lead complications, and higher comorbidities . In this meta‐analysis, we found that the risk reduction was more pronounced in high‐power device; a plausible explanation is because of the implantation of low‐power device has a lower risk of major infections compared to high‐power device and the benefit was not observed because of the small number of events in both AE and control group in low‐power device .…”

Postoperative antibiotic prophylaxis in the prevention of cardiac implantable electronic device infection

“…In our data, 20% of our device-related infections were related to the Gram-negative bacteria. 10 Ciprofloxacin is active against both Gram-positive and Gram-negative bacteria Therefore, we chose the ciprofloxacin to have complete protection against all involved bacteria.…”