Key result
Complicated and isolated pocket infections carry similar mortality risks, both lower than systemic infection.
Why the study?
Cardiac implantable electronic device infection can present with pocket or systemic manifestations, but patients presenting with both pocket and systemic infection remain incompletely characterized.
Does complicated pocket infection have different characteristics and outcomes compared to isolated pocket or systemic infection in patients undergoing CIED extraction?
Cohort (n=300)
Does complicated pocket infection have different characteristics and outcomes compared to isolated pocket or systemic infection in patients undergoing CIED extraction?
p-value: p=<0.001
Complicated pocket infections, despite presenting with systemic features like fever and leukocytosis, have a similar long-term prognosis to isolated pocket infections and should be categorized separately from true systemic CIED infections.
May support distinguishing complicated pocket from systemic CIED infections clinically; hypothesis-generating for refined classification.
Cardiac implantable electronic device (CIED) infection can present with pocket or systemic manifestations, both necessitating complete device removal and pathogen-directed antimicrobial therapy. Here, we aim to characterize those presenting with both pocket and systemic infection. A retrospective analysis of CIED extraction procedures included 300 patients divided into isolated pocket (n = 104, 34.7%), complicated pocket (n = 54, 18%), and systemic infection (n = 142, 47.3%) groups. The systemic and complicated pocket groups frequently presented with leukocytosis and fever > 37.8, as opposed to the isolated pocket group. Staphylococcus aureus was the most common pathogen in the systemic and complicated pocket groups (43.7% and 31.5%, respectively), while Coagulase-negative staphylococci (CONS) predominated (31.7%) in the isolated pocket group (10.6%, p < 0.001). No differences were observed in procedural success or complications rates. Kaplan–Meier survival analysis found that at three years of follow-up, the rate of all-cause mortality was significantly higher among patients with systemic infection compared to both pocket groups (p < 0.001), with the curves diverging at thirty days. In this study, we characterize a new entity of complicated pocket infection. Despite the systemic pattern of infection, their prognosis is similar to isolated pocket infection. We suggest that this special category be presented separately in future publications of CIED infections.
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Milman et al. (2023) conducted a cohort in Cardiac implantable electronic device (CIED) infection (n=300). Complicated pocket infection vs. Isolated pocket and systemic infection was evaluated on All-cause mortality (p=<0.001). Complicated pocket infection had a similar three-year prognosis to isolated pocket infection, with both groups showing significantly lower all-cause mortality than systemic infection (p < 0.001).
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