Cardiac implantable electronic device infection: prevalence and risk factors
Authors: Ghazaryan N , Hovakimyan T , Khachatryan A 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The number of CIED implantation procedures has increased dramatically in recent decades due to population aging and expansion of indications. At the same time, the number of CIED-associated complications has increased too. Infection is a very important and heavy complication of CIED implantation, which significantly increases mortality and morbidity.

Aim and objectives
This study aimed to estimate the risk of CIED-infection in a group of patients who received an aggressive scheme of postprocedural antibiotic therapy and compare with the risk of infection in another group, where a mild antibiotic therapy scheme was used. The study objectives were to assess the incidence and prevalence of CIED-related infection in patients operated in a tertiary cardiovascular center, as well as identify infection-related risk factors.

Methods
A retrospective, observational, cross-sectional study was performed. The study sample included 355 patients, who underwent CIED-related procedure in a single center between 01.12.2017 and 30.07.2020. Two antibiotic prophylaxis and wound follow-up protocols (mild and aggressive) were used. In this study, we compared the effectiveness of both methods to prevent a CIED related infection. Patient’s demographic data, clinical features, comorbidities, the device and procedure-related information were also assessed for having a relationship with CIED infection rate. Data entry and statistical analyses were performed with SPSS version 23 software. Binomial logistic regression analyses were performed for adjusted analyses.

Results
The prevalence of infection was 3.5% in the group with mild scheme and 1.13% in the group with the aggressive scheme. The difference in two subgroups was not significant (p = 0,149). In the whole sample the prevalence of infection was 1,69%.
According to this study severe renal failure with glomerular filtration rate (GFR)&lt;30 mL/min (OR = 32.6, CI = 2.5-420.8, p = 0.008), chronic obstructive pulmonary disease (OR = 8.2, CI = 1.4-47.6, p = 0.019), and thyroid disfunction (OR = 7.065, CI = 1.2-40.6, p = 0.028) were found as significant predictors for having CIED infection. In participants who underwent a reimplantation and in those with postoperative hematoma the odds of having infection was respectively 6.2 fold (CI = 1.086-35.5, p = 0.04) and 48.8 fold (CI = 8.4-285.9, p = 0.028) higher, compared to patients with primary implantation and absence of hematoma.
Age of participants with CIED-infection (mean age = 52.5 ) was younger compared to patients without infection (mean age = 61.2, p = 0.039).

Conclusion
According to our study the risk of infection in our center is comparable to recorded prevalence in other countries. There is no statistically significant difference on CIED infection between mild and aggressive antibiotic therapy schemes.

Recommendations
The routine use of aggressive antibiotic therapy is not justified and carries a risk of microbial resistance, as well as additional healthcare costs.