Cardiac Implantable Electronic Device (CIED) Infections, Associated Risk Factors and Optimization in Reducing CIED Infections; An Experience of Tertiary Care Hospital of Pakistan
DOI:
https://doi.org/10.51253/pafmj.v74i1.8171Keywords:
: Cardiac implantable devices, Risk Factors, Pakistan, DefibrillatorsAbstract
Objective: To determine the frequency of infections in cardiac implantable Electronic device patients, identify risk factors, and look for optimization in reducing Cardiac Implantable Electronic Device infections, with a resultant decrease in mortality and morbidity, decrease in hospital stay, and total expenditure.
Study Design: Cross-sectional study.
Place and Duration of Study: Electrophysiology Department of National Institute of Cardiovascular Diseases, Karachi
Pakistan, from Jul 2019 to Jun 2020.
Methodology: The study was conducted on the patients with cardiac implantable devices. Adult patients of either gender
with cardiac implantable Electronic device and infection were included. Epicardial leads and surgical site infections within six
weeks were excluded.
Results: One thousand and forty-six (1046) patients were enrolled in the study. There were 596(57%) male patients.
385(36.8%) patients were implanted with single chamber pacemakers, 390(37.3%) with dual chamber pacemakers, 146(14%)
single chamber ICD (implantable cardiac defibrillator), 67(6.4%) dual-chamber cardiac implantable Electronic device, 46(4.4%) CRT-D, 12(1.1%) TPM, 134(12.8%) Re-do, 114(10.9%), 114(10.9%) generator change, 20(1.9%) leads revision, 26(2.5%) patients had extraction. The rate of CIED infection was 34(2.1%). The association of the study parameters with infection rate revealed that type of device (p=0.002), extraction, suture type, and post-procedure hematoma (p<0.001) had a statistically significant relationship with infection rate.
Conclusion: The Cardiac Implantable Electronic Device infection rate was 2.1%. Hypertension and diabetes were common risk factors, and left ventricular dysfunction was common in high-energy devices with multiple leads and repeated procedures.
Downloads
References
Gitenay E, Molin F, Blais S, Tremblay V, Gervais P, Plourde B, et
al. Cardiac Implantable Electronic Device Infection: Detailed
Analysis of Cost Implications. Can J Cardiol 2018; 34(8): 1026-
https://doi.org/10.1016/j.cjca.2018.05.001.
Korkerdsup T, Ngarmukos T, Sungkanuparph S, Phuphuakrat A.
Cardiac implantable electronic device infection in the cardiac
referral center in Thailand: incidence, microbiology, risk factors,
and outcomes. J Arrhythm 2018; 34(6): 632-639.
https://doi.org/10.1002/joa3.12123.
Yang PS, Jeong J, You SJ, Yu HT, Kim TH, Sung JH, Lee SS, Park
HD, Joung B. The Burden and Risk Factors for Infection of
Transvenous Cardiovascular Implantable Electronic Device: a
Nationwide Cohort Study. Korean Circ J 2019; 49(8): 742-752.
https://doi.org/10.4070/kcj.2018.0361.
Blomström-Lundqvist C, Traykov V, Erba PA, Burri H, Nielsen JC,
Bongiorni MG, et al; ESC Scientific Document Group. European
Heart Rhythm Association (EHRA) international consensus
document on how to prevent, diagnose, and treat cardiac
implantable electronic device infections-endorsed by the Heart
Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society
(APHRS), the Latin American Heart Rhythm Society (LAHRS),
International Society for Cardiovascular Infectious Diseases
(ISCVID) and the European Society of Clinical Microbiology and
Infectious Diseases (ESCMID) in collaboration with the European
Association for Cardio-Thoracic Surgery (EACTS). Europace
; 22(4): 515-549. https://doi.org/10.1093/europace/euz246.
Clémenty N, Carion PL, Léotoing L, Lamarsalle L, Wilquin-Bequet
F, Brown B, et al. Infections and associated costs following
cardiovascular implantable electronic device implantations: a
nationwide cohort study. Europace 2018; 20(12): 1974-1980.
https://doi.org/10.1093/europace/eux387.
Hussein AA, Tarakji KG, Martin DO, Gadre A, Fraser T, Kim A,
et al. Cardiac Implantable Electronic Device Infections: Added
Complexity and Suboptimal Outcomes With Previously
Abandoned Leads. JACC Clin Electrophysiol 2017; 3(1): 1-9.
https://doi.org/10.1016/j.jacep.2016.06.009.
Sridhar AR, Lavu M, Yarlagadda V, Reddy M, Gunda S, Afzal R,
et al. Cardiac Implantable Electronic Device-Related Infection
and Extraction Trends in the U.S. Pacing Clin Electrophysiol
; 40(3): 286-293. https://doi.org/10.1111/pace.13009.
Krahn AD , Longtin Y , Philippon F , Birnie DH , Manlucu J ,
Angaran P, et al. Prevention of Arrhythmia Device Infection
Trial: The PADIT Trial. J Am Coll Cardiol 2018; 72(24): 3098-3109.
https://doi.org/10.1016/j.jacc.2018.09.068.
Tarakji KG , Mittal S , Kennergren C , Corey R , Poole JE , Schloss
E, et al ; WRAP-IT Investigators. Antibacterial Envelope to
Prevent Cardiac Implantable Device Infection. N Engl J Med
; 380(20): 1895-1905.
https://doi.org/10.1056/NEJMoa1901111.
Joy PS, Kumar G, Poole JE, London B, Olshansky B. Cardiac
implantable electronic device infections: Who is at greatest risk?
Heart Rhythm 2017; 14(6): 839-845.
https://doi.org/10.1016/j.hrthm.2017.03.019.
. Romeyer-Bouchard C, Da Costa A, Dauphinot V, Messier M,
Bisch L, Samuel B, et al. Prevalence and risk factors related to
infections of cardiac resynchronization therapy devices. Eur
Heart J 2010; 31(2): 203-210.
https://doi.org/10.1093/eurheartj/ehp421.
Birnie DH , Wang J , Alings M , Philippon F , Parkash R ,
Manlucu J, et al. Risk Factors for Infections Involving Cardiac
Implanted Electronic Devices. J Am Coll Cardiol 2019; 74(23):
-2854. https://doi.org/10.1016/j.jacc.2019.09.060.
Wang R, Li X, Wang Q, Zhang Y, Wang H. Corrigendum:
Microbiological Characteristics and Clinical Features of Cardiac
Implantable Electronic Device Infections at a Tertiary Hospital in
China. Front Microbiol 2017; 8: 928.
https://doi.org/10.3389/fmicb.2017.00928.
Greenspon AJ, Eby EL, Petrilla AA, Sohail MR. Treatment
patterns, costs, and mortality among Medicare beneficiaries with
CIED infection. Pacing Clin Electrophysiol 2018; 41(5): 495-503.
https://doi.org/10.1111/pace.13300.
Wilkoff BL , Boriani G , Mittal S , Poole JE , Kennergren C , Corey
GR, et al; WRAP-IT Investigators. Impact of Cardiac Implantable
Electronic Device Infection: A Clinical and Economic Analysis of
the WRAP-IT Trial. Circ Arrhythm Electrophysiol 2020; 13(5):
e008280. https://doi.org/10.1161/CIRCEP.119.008280.
Sridhar AR , Lavu M , Yarlagadda V , Reddy M , Gunda S , Afzal
R, et al. Cardiac Implantable Electronic Device-Related Infection
and Extraction Trends in the U.S. Pacing Clin Electrophysiol
; 40(3): 286-293. https://doi.org/10.1111/pace.13009.
Ahmed FZ , Fullwood C , Zaman M , Qamruddin A , Cunnington
C , Mamas MA, et al. Cardiac implantable electronic device
(CIED) infections are expensive and associated with prolonged
hospitalisation: UK Retrospective Observational Study. PLoS
One 2019; 14(1): e0206611.
https://doi.org/10.1371/journal.pone.0206611.
Ludwig S, Theis C, Brown B, Witthohn A, Lux W, Goette A.
Incidence and costs of cardiac device infections: retrospective
analysis using German health claims data. J Comp Eff Res 2018;
(5): 483-492. https://doi.org/10.2217/cer-2017-0080
Downloads
Published
Issue
Section
How to Cite
