Elevated creatinine (≥1.5 mg/dL) significantly increased the risk of pacemaker or ICD infection compared to controls (38% vs 12%; OR 4.6; P<0.001).
Case-Control (n=152)
No
Does renal insufficiency increase the risk of infection in patients undergoing pacemaker or ICD surgery?
Renal insufficiency is a potent risk factor for pacemaker and ICD infections, increasing the odds of infection nearly five-fold.
Effect estimate: OR 4.6
Absolute Event Rate: 38% vs 12%
p-value: p=< 0.001
BACKGROUND: Pacemakers and implanted cardioverter defibrillator (ICD) infection rates are rising. Renal insufficiency impairs immune function and is known to increase the risk of infection following implantation of orthopedic hardware. The purpose of the current study is to characterize the risk factors for pacemaker and ICD infection and to evaluate the role of renal insufficiency in this complication. METHODS AND RESULTS: A large (n = 4,856) single center experience with pacemaker and ICD procedures was reviewed. Of these, 141 were extractions of infected devices and 76 of these patients had been implanted in the Emory system and had preimplant creatinine information available for analysis. These cases were compared to 76 control patients undergoing device implantation matched by date of implant who had no infective complications. Demographic and clinical data from both groups were compared using both univariate and multivariate analysis. The overall rate of infection was 1.5%. Patients with device infection were more likely to have congestive heart failure (CHF), be diabetic, have generator exchanges, and to take warfarin than controls. There was no difference in the prevalence of coronary disease, atrial fibrillation, steroid use, or malignancy between the two groups. Elevated creatinine (Cr > or = 1.5 mg/dL) was much more frequent in patients with infection than in controls (38% vs 12%, odds ratio 4.6, P < 0.001). Moderate to severe renal disease (GFR < or = 60 cc/min/1.73 m2) was the most potent risk factor for infection, with a prevalence of 42% in infected patients versus 13% in controls (odds ratio of 4.8). CONCLUSIONS: Renal insufficiency dramatically increases the risk of infection complicating pacemaker or ICD surgery. This association should be part of the risk-benefit consideration prior to device implantation. Additional study of more extensive perioperative antibiotic therapy in this subset of patients is warranted.
Bloom et al. (2006) conducted a case-control in Pacemaker or ICD infection (n=152). Elevated creatinine (≥ 1.5 mg/dL) vs. Normal creatinine was evaluated on Pacemaker or ICD infection (OR 4.6, p=< 0.001). Elevated creatinine (≥1.5 mg/dL) significantly increased the risk of pacemaker or ICD infection compared to controls (38% vs 12%; OR 4.6; P<0.001).