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; P=0.0001), stage 3 chronic kidney disease (OR=9.41; 95% CI, 1.77–50.04; P=0.009), a revision procedure (OR=8.8; 95% CI, 3.37–23.2; P=0.0001), or postoperative hematoma (OR=6.9; 95% CI, 1.58–30.2; P=0.01). We also identified 2 novel predictors of infection: a low body mass index of <20 kg/m2 (OR=1.03; 95% CI, 1.01–1.06; P=0.005), and use of povidone-iodine rather than chlorhexidine-alcohol for topical antisepsis (OR=4.4; 95% CI, 2.01–9.4; P=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.