Variability in clinical features of early versus late cardiovascular implantable electronic device pocket infections

Mariko Welch, Daniel Z. Uslan, Arnold J. Greenspon, Muhammad R. Sohail, Larry M. Baddour, Elisabeth Blank, Roger G. Carrillo, Stephan B. Danik, Ana Del Rio, Walter Hellinger, Katherine Y. Le, Jose M. Miro, Christoph Naber, James E. Peacock, Holenarasipur R. Vikram, Chi Hong Tseng, Jordan M. Prutkin

Research output: Contribution to journalArticle

19 Scopus citations

Abstract

Background Cardiovascular implantable electronic device (CIED) pocket infections are often related to recent CIED placement or manipulation, but these infections are not well characterized. The clinical presentation of CIED pocket infection, based on temporal onset related to last CIED procedure, deserves further study. Methods The MEDIC (Multicenter Electrophysiologic Device Infection Cohort) prospectively enrolled subjects with CIED infection. Subjects were stratified into those whose infection occurred <12 months (early) or ≥12 months (late) since their last CIED-related procedure. Results There were 132 subjects in the early group and 106 in the late group. There were more females (P = 0.009) and anticoagulation use (P = 0.039) in the early group. Subjects with early infections were more likely to have had a generator change or lead addition as their last procedure (P = 0.03) and had more prior CIED procedures (P = 0.023). Early infections were more likely to present with pocket erythema (P < 0.001), swelling (P < 0.001), and pain (P = 0.007). Late infections were more likely to have pocket erosion (P = 0.005) and valvular vegetations (P = 0.009). In bacteremic subjects, early infections were more likely healthcare-associated (P < 0.001). In-hospital and 6-month mortality were equivalent. Conclusion A total of 45% of patients with CIED pocket infection presented >12 months following their last CIED-related procedure. Patients with early infection were more likely to be female, on anticoagulation, and present with localized inflammation, whereas those with late infection were more likely to have CIED erosion or valvular endocarditis.

Original languageEnglish (US)
Pages (from-to)955-962
Number of pages8
JournalPACE - Pacing and Clinical Electrophysiology
Volume37
Issue number8
DOIs
StatePublished - Aug 2014

Keywords

  • cardiac implantable devices
  • device infection
  • endocarditis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of 'Variability in clinical features of early versus late cardiovascular implantable electronic device pocket infections'. Together they form a unique fingerprint.

  • Cite this

    Welch, M., Uslan, D. Z., Greenspon, A. J., Sohail, M. R., Baddour, L. M., Blank, E., Carrillo, R. G., Danik, S. B., Del Rio, A., Hellinger, W., Le, K. Y., Miro, J. M., Naber, C., Peacock, J. E., Vikram, H. R., Tseng, C. H., & Prutkin, J. M. (2014). Variability in clinical features of early versus late cardiovascular implantable electronic device pocket infections. PACE - Pacing and Clinical Electrophysiology, 37(8), 955-962. https://doi.org/10.1111/pace.12385