title: Cardiac device infections are associated with a significant mortality risk.
abstract: BACKGROUND
  Cardiac device infections (CDIs) are a serious complication associated with the implantation of cardiac rhythm devices. However, the effect of CDI on the subsequent risk of mortality is unknown.
  
  
  OBJECTIVE
  To assess the prognostic importance of CDI in recipients of implantable cardioverter-defibrillator and cardiac resynchronization therapy - defibrillator.
  
  
  METHODS
  All patients who received their initial implantable cardioverter-defibrillator/cardiac resynchronization therapy - defibrillator between January 2000 and September 2009 were included. During follow-up, the occurrence of CDI and all-cause mortality were noted. The prognostic importance of the first CDI on mortality was assessed by modeling CDI as a time-dependent covariate in the Cox proportional hazards model.
  
  
  RESULTS
  A total of 2476 patients (79% men; mean age 62 ± 13 years) were included in this analysis. During follow-up, CDI occurred in 64 (2.6%) patients. The 1-year mortality following first CDI was 16.9% (95% confidence interval 6.7%-27.1%). Experiencing the first CDI was associated with a 1.9-fold (hazard ratio 1.87; 95% confidence interval 1.07-3.26) increased risk of mortality compared to patients who did not experience CDI. After controlling for possible confounders, this increased to a 2.4-fold (hazard ratio 2.40; 95% confidence interval 1.35-4.28) increased risk of mortality.
  
  
  CONCLUSIONS
  In a large cohort of patients who receive implantable cardioverter-defibrillator/cardiac resynchronization therapy - defibrillator after their initial implant, the 3-year incidence of CDI was 2.6%. The occurrence of CDI was associated with substantial 1-year mortality, and patients experiencing CDI had a more than 2-fold increased risk of mortality compared with patients who remained free from CDI.
authors: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors: Mihály K
authors: MK
authors: de Bie
authors: Johannes B
authors: JB
authors: van Rees
authors: J
authors: J
authors: Thijssen
authors: C Jan Willem
authors: CJ
authors: Borleffs
authors: Serge A
authors: SA
authors: Trines
authors: Suzanne C
authors: SC
authors: Cannegieter
authors: Martin J
authors: MJ
authors: Schalij
authors: Lieselot
authors: L
authors: van Erven
mesh_terms: D001424:Bacterial Infections / Q000453:epidemiology / Q000209:etiology / Q000401:mortality*; D016001:Confidence Intervals; D017147:Defibrillators, Implantable / Q000009:adverse effects* / Q000706:statistics & numerical data; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology / Q000209:etiology / Q000401:mortality*; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D009426:Netherlands / Q000453:epidemiology; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk