title: Risk factors associated with early- versus late-onset implantable cardioverter-defibrillator infections.
abstract: OBJECTIVE
  The infection rates of implantable cardioverter-defibrillators 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.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA. sohail.muhammad@mayo.edu
authors.forename: Muhammad R
authors.initials: MR
authors.lastname: Sohail
authors.forename: Salwa
authors.initials: S
authors.lastname: Hussain
authors.forename: Katherine Y
authors.initials: KY
authors.lastname: Le
authors.forename: Chadi
authors.initials: C
authors.lastname: Dib
authors.forename: Christine M
authors.initials: CM
authors.lastname: Lohse
authors.forename: Paul A
authors.initials: PA
authors.lastname: Friedman
authors.forename: David L
authors.initials: DL
authors.lastname: Hayes
authors.forename: Daniel Z
authors.initials: DZ
authors.lastname: Uslan
authors.forename: Walter R
authors.initials: WR
authors.lastname: Wilson
authors.forename: James M
authors.initials: JM
authors.lastname: Steckelberg
authors.forename: Larry M
authors.initials: LM
authors.lastname: Baddour
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000628:therapy*; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D017848:Blood-Borne Pathogens / Q000302:isolation & purification; D016022:Case-Control Studies; D016001:Confidence Intervals; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D020878:Device Removal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D016459:Prosthesis-Related Infections / Q000453:epidemiology* / Q000382:microbiology* / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D013997:Time Factors; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents