Risk factors associated with early-versus late-onset implantable cardioverter-defibrillator infections

Muhammad R. Sohail, Salwa Hussain, Katherine Y. Le, Chadi Dib, Christine M. Lohse, Paul Andrew Friedman, David L. Hayes, Daniel Z. Uslan, Walter R. Wilson, James M. Steckelberg, Larry M. Baddour

Research output: Contribution to journalArticle

50 Citations (Scopus)

Abstract

Aims The infection rates of implantable cardioverterdefibrillators systems (ICDs) are higher than that of permanent pacemaker. Risk factors associated with ICD infection have not been characterized and are the subject of the current investigation. Methods All patients who had an ICD implanted at Mayo Clinic Rochester between 1991 and 2008 were retrospectively reviewed. Each case of ICD infection was matched with two non-infected controls. Cases of ICD infection were further stratified by early- (≤6 months) versus late-onset (>6 months) infection. Multivariable analysis was performed to identify significant risk factors for ICD infection. Results Sixty-eight patients with ICD infection and 136 matched controls met the inclusion criteria. Thirty-five cases presented with early-onset infection and 33 had late-onset device infection. Staphylococcal species were the most common pathogens in both groups of patients. Patients with early-onset infection were more likely to present with generator pocket infection (p=0.02). Patients with multiple comorbid conditions (high Charlson index) tended to have longer hospital stay during implantation admission (p=0.009). In a multivariable logistic regression model, the presence of epicardial leads (odds ratio (OR)=9.7, p=0.03) and postoperative complications at the generator pocket (OR=27.2, p<0.001) were significant risk factors for early-onset ICD infection, whereas longer duration of hospitalization at the time of implantation (2 days versus 1 day: OR=33.1, p<0.001; ≥3 days versus 1 day: OR=49.0, p<0.001) and chronic obstructive pulmonary disease (OR=9.8, p=0.02) were associated with late-onset infections. Conclusions Our study findings suggest that risk factors associated with early- and late-onset ICD infection are different. While circumstances that may increase the chances of pocket contamination in the perioperative period are more likely to be associated with early-onset ICD infection, overall poor health of the host may increase the likelihood of late-onset ICD infection. These factors should be considered when developing strategies to minimize risk of device infection.

Original languageEnglish (US)
Pages (from-to)171-183
Number of pages13
JournalJournal of Interventional Cardiac Electrophysiology
Volume31
Issue number2
DOIs
StatePublished - Aug 2011

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Implantable Defibrillators
Infection
Odds Ratio
Logistic Models
Equipment and Supplies
Perioperative Period

Keywords

  • ICD
  • Implantable cardioverter-defibrillator
  • Infection
  • Risk factor

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Risk factors associated with early-versus late-onset implantable cardioverter-defibrillator infections. / Sohail, Muhammad R.; Hussain, Salwa; Le, Katherine Y.; Dib, Chadi; Lohse, Christine M.; Friedman, Paul Andrew; Hayes, David L.; Uslan, Daniel Z.; Wilson, Walter R.; Steckelberg, James M.; Baddour, Larry M.

In: Journal of Interventional Cardiac Electrophysiology, Vol. 31, No. 2, 08.2011, p. 171-183.

Research output: Contribution to journalArticle

Sohail, MR, Hussain, S, Le, KY, Dib, C, Lohse, CM, Friedman, PA, Hayes, DL, Uslan, DZ, Wilson, WR, Steckelberg, JM & Baddour, LM 2011, 'Risk factors associated with early-versus late-onset implantable cardioverter-defibrillator infections', Journal of Interventional Cardiac Electrophysiology, vol. 31, no. 2, pp. 171-183. https://doi.org/10.1007/s10840-010-9537-x
Sohail, Muhammad R. ; Hussain, Salwa ; Le, Katherine Y. ; Dib, Chadi ; Lohse, Christine M. ; Friedman, Paul Andrew ; Hayes, David L. ; Uslan, Daniel Z. ; Wilson, Walter R. ; Steckelberg, James M. ; Baddour, Larry M. / Risk factors associated with early-versus late-onset implantable cardioverter-defibrillator infections. In: Journal of Interventional Cardiac Electrophysiology. 2011 ; Vol. 31, No. 2. pp. 171-183.
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abstract = "Aims The infection rates of implantable cardioverterdefibrillators systems (ICDs) are higher than that of permanent pacemaker. Risk factors associated with ICD infection have not been characterized and are the subject of the current investigation. Methods All patients who had an ICD implanted at Mayo Clinic Rochester between 1991 and 2008 were retrospectively reviewed. Each case of ICD infection was matched with two non-infected controls. Cases of ICD infection were further stratified by early- (≤6 months) versus late-onset (>6 months) infection. Multivariable analysis was performed to identify significant risk factors for ICD infection. Results Sixty-eight patients with ICD infection and 136 matched controls met the inclusion criteria. Thirty-five cases presented with early-onset infection and 33 had late-onset device infection. Staphylococcal species were the most common pathogens in both groups of patients. Patients with early-onset infection were more likely to present with generator pocket infection (p=0.02). Patients with multiple comorbid conditions (high Charlson index) tended to have longer hospital stay during implantation admission (p=0.009). In a multivariable logistic regression model, the presence of epicardial leads (odds ratio (OR)=9.7, p=0.03) and postoperative complications at the generator pocket (OR=27.2, p<0.001) were significant risk factors for early-onset ICD infection, whereas longer duration of hospitalization at the time of implantation (2 days versus 1 day: OR=33.1, p<0.001; ≥3 days versus 1 day: OR=49.0, p<0.001) and chronic obstructive pulmonary disease (OR=9.8, p=0.02) were associated with late-onset infections. Conclusions Our study findings suggest that risk factors associated with early- and late-onset ICD infection are different. While circumstances that may increase the chances of pocket contamination in the perioperative period are more likely to be associated with early-onset ICD infection, overall poor health of the host may increase the likelihood of late-onset ICD infection. These factors should be considered when developing strategies to minimize risk of device infection.",
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AU - Sohail, Muhammad R.

AU - Hussain, Salwa

AU - Le, Katherine Y.

AU - Dib, Chadi

AU - Lohse, Christine M.

AU - Friedman, Paul Andrew

AU - Hayes, David L.

AU - Uslan, Daniel Z.

AU - Wilson, Walter R.

AU - Steckelberg, James M.

AU - Baddour, Larry M.

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N2 - Aims The infection rates of implantable cardioverterdefibrillators systems (ICDs) are higher than that of permanent pacemaker. Risk factors associated with ICD infection have not been characterized and are the subject of the current investigation. Methods All patients who had an ICD implanted at Mayo Clinic Rochester between 1991 and 2008 were retrospectively reviewed. Each case of ICD infection was matched with two non-infected controls. Cases of ICD infection were further stratified by early- (≤6 months) versus late-onset (>6 months) infection. Multivariable analysis was performed to identify significant risk factors for ICD infection. Results Sixty-eight patients with ICD infection and 136 matched controls met the inclusion criteria. Thirty-five cases presented with early-onset infection and 33 had late-onset device infection. Staphylococcal species were the most common pathogens in both groups of patients. Patients with early-onset infection were more likely to present with generator pocket infection (p=0.02). Patients with multiple comorbid conditions (high Charlson index) tended to have longer hospital stay during implantation admission (p=0.009). In a multivariable logistic regression model, the presence of epicardial leads (odds ratio (OR)=9.7, p=0.03) and postoperative complications at the generator pocket (OR=27.2, p<0.001) were significant risk factors for early-onset ICD infection, whereas longer duration of hospitalization at the time of implantation (2 days versus 1 day: OR=33.1, p<0.001; ≥3 days versus 1 day: OR=49.0, p<0.001) and chronic obstructive pulmonary disease (OR=9.8, p=0.02) were associated with late-onset infections. Conclusions Our study findings suggest that risk factors associated with early- and late-onset ICD infection are different. While circumstances that may increase the chances of pocket contamination in the perioperative period are more likely to be associated with early-onset ICD infection, overall poor health of the host may increase the likelihood of late-onset ICD infection. These factors should be considered when developing strategies to minimize risk of device infection.

AB - Aims The infection rates of implantable cardioverterdefibrillators systems (ICDs) are higher than that of permanent pacemaker. Risk factors associated with ICD infection have not been characterized and are the subject of the current investigation. Methods All patients who had an ICD implanted at Mayo Clinic Rochester between 1991 and 2008 were retrospectively reviewed. Each case of ICD infection was matched with two non-infected controls. Cases of ICD infection were further stratified by early- (≤6 months) versus late-onset (>6 months) infection. Multivariable analysis was performed to identify significant risk factors for ICD infection. Results Sixty-eight patients with ICD infection and 136 matched controls met the inclusion criteria. Thirty-five cases presented with early-onset infection and 33 had late-onset device infection. Staphylococcal species were the most common pathogens in both groups of patients. Patients with early-onset infection were more likely to present with generator pocket infection (p=0.02). Patients with multiple comorbid conditions (high Charlson index) tended to have longer hospital stay during implantation admission (p=0.009). In a multivariable logistic regression model, the presence of epicardial leads (odds ratio (OR)=9.7, p=0.03) and postoperative complications at the generator pocket (OR=27.2, p<0.001) were significant risk factors for early-onset ICD infection, whereas longer duration of hospitalization at the time of implantation (2 days versus 1 day: OR=33.1, p<0.001; ≥3 days versus 1 day: OR=49.0, p<0.001) and chronic obstructive pulmonary disease (OR=9.8, p=0.02) were associated with late-onset infections. Conclusions Our study findings suggest that risk factors associated with early- and late-onset ICD infection are different. While circumstances that may increase the chances of pocket contamination in the perioperative period are more likely to be associated with early-onset ICD infection, overall poor health of the host may increase the likelihood of late-onset ICD infection. These factors should be considered when developing strategies to minimize risk of device infection.

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KW - Implantable cardioverter-defibrillator

KW - Infection

KW - Risk factor

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