Retrospective study of post-operative infections in implantable cardiac devices in a cardiac tertiary care center

Abstract

BACKGROUND: The rise in the incidence of implantation is one of the main causes behind the increased rate of CIED infection, which is considered as a serious life-threatening complication. The need of risk factor assessment has become a necessity to prevent further complications and provide prompt management. OBJECTIVES: Identify the risk factors of infection postoperatively among patients who have implantable cardiac devices. DESIGN: A retrospective case-control study. SETTINGS: Cardiac center for adults. PATIENTS AND METHODS: The study included all adult patients (≥14 years of age) of all nationalities who underwent cardiac electronic device implantation that was managed in the cardiac center between January 2012 to December 2018. MAIN OUTCOME MEASURES: Cardiac device infection and associated risk factors. SAMPLE SIZE: 213, including 23 (10.8%) infected case patients and 190 (89.2%) non-infected controls. RESULTS: The mean (SD) age of non-infected patients was 45.0 (12.7) years compared with 61.7 (13.7) for infected patients (P<.0001). Anticoagulant use, hypertension, dysplipdemia and age were the most common patient-related risk factors associated with infection. For procedural and post-procedural risk factors, the risk of infection increased as the number of leads and length of procedure increased. The device most often related to infection was the pacemaker. In the multivariate analysis, longer procedure, greater number of leads, older age, anticoagulant use, and implanted pacemaker device were independently associated with infection. CONCLUSION: We advise the prompt use of strict preoperative antiseptic prophylaxis measures and follow-up for post-implant patients along with patient education for early signs of infections, which will lead to improvement of both diagnosis and treatment quality for our patients in addition to reducing the economic impact on the health care system by minimizing infectious complications. LIMITATIONS: Single tertiary center study, small sample size. CONFLICT OF INTEREST: None.

Vacuum-Implemented Removal of Lead Vegetations in Cardiac Device-Related Infective Endocarditis

“…The presence of an intravascular foreign material is the most important predisposing factor for early or late microorganism colonization, an issue that can be only partially controlled by improved implantation techniques and device technologies. In fact, early CDRIE can affect more than 10% of patients, especially in the older age groups [ 19 ], and the risk of late CDRIE cumulates every year from implantation [ 1 ]. Prompting the removal of the infected device can impact the patient′s outcome positively [ 20 ], particularly when a systemic infection is present.…”