Key result
Previous CIED infection was strongly associated with subsequent CIED infection (OR 48.56, 95% CI 3.72-633.62, P=0.003), as was generator revision procedure (OR 19.99, P=0.033).
Why the study?
What are the incidence, microbiology, risk factors, and outcomes of CIED infection in a Thai cardiac referral center?
Case-Control (n=54)
No
What are the incidence, microbiology, risk factors, and outcomes of CIED infection in a Thai cardiac referral center?
Odds Ratio: 48.56 (95% CI 3.72–633.62)
p-value: p=0.003
In a Thai referral center, CIED infection incidence is stable at 0.9%, with previous infection and generator revision identified as major risk factors, and leaving the device in situ strongly associated with poor outcomes.
Prior CIED infection or generator revision may identify high-risk patients for closer surveillance; supports risk stratification in Asian cohorts but leaves causal inference open.
Background Despite the long experience of cardiac implantable electronic device (CIED) implantation in Thailand, epidemiology of CIED infection in Thailand has never been studied. Methods A retrospective cohort study was conducted at the cardiac referral center in Thailand to investigate incidence of CIED infection and causative organisms between October 2002 and December 2017. A matched case‐control study was performed to determine the factors associated with CIED infection. Results Incidence of CIED infection was 0.9% with a stable trend during the studied period. There were 54 episodes of CIED infection. The median (interquartile range) age of the patients was 67.5 (53.0‐75.0) years. A total of 29 (53.7%), 18 (33.3%), and 7 (13.0%) were permanent pacemaker, automatic implantable cardioverter‐defibrillator, and cardio‐resynchronization therapy‐related infection, respectively. Gram‐positive cocci were the most common organism (24 episodes, 44.4%). Gram‐negative bacilli were isolated in six episodes (11.1%). About 9.3% were polymicrobial and 35.2% were culture negative. Multivariate analysis showed that previous CIED infection and generator revision procedure were associated with CIED infection (odds ratio [OR] 48.56, 95% confidence interval [CI] 3.72‐633.62; P = 0.003 and OR 19.99, 95% CI 1.28‐333.24; P = 0.033 respectively). Forty (74.1%) cases were cured. Leaving device in situ was the only factor significantly associated with poor outcome (OR 11.40, 95% CI 1.52‐85.73; P = 0.018). Conclusions In Thailand, while CIED implantation is rising, incidence of CIED infection is stable. Microbiology of CIED infection in Thailand is similar to western countries, albeit a higher proportion of negative culture. Previous CIED infection and generator revision procedure are associated with CIED infection.
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Korkerdsup et al. (2018) conducted a case-control in Cardiac implantable electronic device (CIED) infection (n=54). Previous CIED infection vs. No previous CIED infection was evaluated on CIED infection (OR 48.56, 95% CI 3.72-633.62, p=0.003). Previous CIED infection was strongly associated with subsequent CIED infection (OR 48.56, 95% CI 3.72-633.62, P=0.003), as was generator revision procedure (OR 19.99, P=0.033).
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