Redo procedures and chronic renal dysfunction are associated with higher risk of cardiac electronic device infections

BACKGROUND: Infection is a major complication of pacemaker (PM) and implantable cardioverter-defibrillator (ICD) implantation. The present study sought to analyze the incidence rate of device infections, to investigate possible relationships between first implantations/repeated procedures and infection rates, and to identify some main risk factors associated with infection of cardiac implantable electronic devices (CIED). METHODS: In a single center retrospective observational study, records of 3899 consecutive patients having undergone PM and ICD implantation, cardiac resynchronization therapy (CRT) or revision (device/lead replacements or upgrades) and between 2002 and 2012 were obtained. RESULTS: Over a mean follow-up period of 66±14 months, a total of 50 patients were identified as having CIED infection (0.85% per procedure and 1.28% per patient). Chronic renal dysfunction and repeated procedures were independently associated with higher risk of CIED infection on multivariate analysis (respectively, OR 1.30, 95% CI: 1.16-1.57, P<0.0001; OR 1.23, 95% CI: 1.12-1.42, P<0.0001). Staphylococcal species was responsible for the bulk of CIED infections (70% of all positive cultures). Coagulase-negative staphylococci were found more frequently than staphylococcus aureus (30% vs. 12%). CONCLUSIONS: The infection rate after cardiac electronic device procedures was low over the follow-up period. Repeated procedures and chronic renal dysfunction were associated with higher risk of CIED infection. Staphylococcal species were mainly responsible for device infections.