Primary/isolated bacteremia and device-related infective endocarditis were associated with significantly higher mortality compared to primary pocket site infection (HR 2.3 and 2.5, respectively).
Cohort (n=387)
No
Does the type of CIED infection (PIB or DRIE vs PPSI) affect mortality in patients undergoing device extraction?
CIED infections presenting as primary bacteremia or infective endocarditis without pocket involvement carry a significantly higher mortality risk than primary pocket site infections.
Effect estimate: HR 2.3 (PIB), HR 2.5 (DRIE) (95% CI 1.2-4.6 (PIB), 1.6-4.1 (DRIE))
BACKGROUND: A steady rise in the use of cardiovascular implantable electronic devices (CIEDs), particularly in the elderly, has led to an increase in device-related infections. Although often studied and reported as a single entity, these complications in fact comprise a heterogeneous group. Specific subgroups may be associated with distinct mortality risks. METHODS: Medical records of all patients who underwent device extraction for CIED-related infection at a single tertiary referral center between 1991 and 2007 were reviewed. Infections were divided into four subgroups: primary pocket site infection (PPSI), pocket site infection with bacteremia, primary/isolated bacteremia (PIB), and device-related infective endocarditis (DRIE). Clinical presentation, laboratory data, and mortality rates were obtained by chart review and by querying the Social Security Death Index. RESULTS: A total of 387 cases were analyzed. The overall in-hospital and 1-year all-cause mortality rates were 7.2% and 25.3%, respectively. Patients with PIB or DRIE had significantly higher mortality rates (hazard ratio HR 2.3; 95% confidence interval CI 1.2-4.6 and HR 2.5; 95% CI 1.6-4.1, respectively) when compared with patients in the PPSI group. Patients who did not receive a new device during the initial admission also had a higher 1-year mortality rate compared to those who did (HR 2.7; 95% CI 1.8-4.1). CONCLUSIONS: Our patients with CIED-related infections requiring extraction/hospitalization had a significant mortality risk. Presence of pocket site infection carried a more favorable prognosis, regardless of the presence of bacteremia. Early detection and prevention of CIED-related infections with PIB (i.e., no pocket site involvement), especially for high-risk populations, is needed.
Lee et al. (Wed,) conducted a cohort in Cardiovascular implantable electronic device (CIED) infection (n=387). Primary/isolated bacteremia (PIB) or device-related infective endocarditis (DRIE) vs. Primary pocket site infection (PPSI) was evaluated on 1-year all-cause mortality (HR 2.3 (PIB), HR 2.5 (DRIE), 95% CI 1.2-4.6 (PIB), 1.6-4.1 (DRIE)). Primary/isolated bacteremia and device-related infective endocarditis were associated with significantly higher mortality compared to primary pocket site infection (HR 2.3 and 2.5, respectively).