Risk factors related to infections of implanted pacemakers and cardioverter-defibrillators: results of a large prospective study.
BACKGROUND
The Prospective Evaluation of Pacemaker Lead Endocarditis study is a multicenter, prospective survey of the incidence and risk factors of infectious complications after implantation of pacemakers and cardioverter-defibrillators.


RESULTS
Between January 1, 2000, and December 31, 2000, 6319 consecutive recipients of implantable systems were enrolled at 44 medical centers and followed up for 12 months. All infectious complications were recorded, and their occurrence was related to the baseline demographic, clinical, and procedural characteristics. Among 5866 pacing systems, 3789 included 2 and 117 had >2 leads; among 453 implantable cardioverter-defibrillators, 178 were dual-lead systems. A total of 4461 de novo implantations occurred and 1858 pulse generator or lead replacements. Reinterventions were performed before hospital discharge in 101 patients. Single- and multiple-variable logistic regression analyses were performed to identify risk factors; adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated. At 12 months, device-related infections were reported in 42 patients (0.68%; 95% CI, 0.47 to 0.89). The occurrence of infection was positively correlated with fever within 24 hours before the implantation procedure (aOR, 5.83; 95% CI, 2.00 to 16.98), use of temporary pacing before the implantation procedure (aOR, 2.46; 95% CI, 1.09 to 5.13), and early reinterventions (aOR, 15.04; 95% CI, 6.7 to 33.73). Implantation of a new system (aOR, 0.46; 95% CI, 0.24 to 0.87) and antibiotic prophylaxis (aOR, 0.4; 95% CI, 0.18 to 0.86) were negatively correlated with risk of infection.


CONCLUSIONS
This study identified several factors of risk of device infection and confirmed the efficacy of antibiotic prophylaxis in recipients of new or replacement pacemakers or implantable cardioverter-defibrillators.
Klug
Didier
D
Department of Cardiology A, Hôpital Cardiologique de Lille, CHRU, 59037, Lille Cedex, France. dklug@chru-lille.fr
Balde
Mamadou
M
Pavin
Dominique
D
Hidden-Lucet
Françoise
F
Clementy
Jacques
J
Sadoul
Nicolas
N
Rey
Jean Luc
JL
Lande
Gilles
G
Lazarus
Arnaud
A
Victor
Jacques
J
Barnay
Claude
C
Grandbastien
Bruno
B
Kacet
Salem
S
D000368:Aged; D000369:Aged, 80 and over; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D017147:Defibrillators, Implantable / Q000009:adverse effects* / Q000706:statistics & numerical data; D004696:Endocarditis / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D004867:Equipment Design; D005260:Female; D005334:Fever / Q000453:epidemiology; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects* / Q000706:statistics & numerical data; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control / Q000628:therapy; D012042:Registries / Q000706:statistics & numerical data; D012086:Reoperation / Q000706:statistics & numerical data; D012307:Risk Factors