Case-Control Study of Surgical Site Infections Associated With Pacemakers and Implantable Cardioverter-Defibrillators

OBJECTIVE: In 2000, the rate of surgical site infections (SSIs) associated with pacemaker and implantable cardioverter-defibrillator (ICD) procedures performed in the cardiothoracic operating rooms of hospital A was 16% (19 of 116 procedures resulted in infections). This study investigates risks for SSI associated with these procedures in the cardiothoracic operating room. DESIGN: Unmatched 1: 3 case-control study performed over a 12-month period among patients who had undergone implantation of a pacemaker and/or ICD. A standardized observation scrutinized infection control practices in the area where the procedures were performed. SETTING: The cardiothoracic operating rooms of hospital A, which belongs to a hospital consortium in the midwestern United States. PATIENTS: Patients with SSI were identified as case patients. Control patients were chosen from the group of uninfected patients who had procedures performed during the same period as case patients. RESULTS: A total of 19 SSIs associated with pacemaker and ICD procedures were retrospectively identified among the patients who underwent procedures in these cardiothoracic operating rooms. Culture samples were obtained from 7 patients; 2 yielded coagulase-negative Staphylococcus on culture, 2 yielded Staphylococcus aureus, 1 yielded Serratia marcescens, and 2 showed no growth. In the case-control study, age, race, sex, diabetes mellitus, smoking history, timing of antibiotic therapy, and hair removal did not differ significantly between case patients and control patients. Case patients were more likely to have an abdominal device in place (odds ratio OR, 5. 5 95% confidence interval CI, 1. 6-19. 3; P=. 006) and less likely to have received a new implant (OR 0. 3 95% CI, 0. 1-0. 8; P=. 02) or to have had new leads placed (OR, 0. 2 95% CI, 0. 1-0. 6; P=. 003). CONCLUSIONS: Abdominal placement of implanted devices was associated with occurrence of an SSI after pacemaker and/or ICD procedures.