title: Cardiovascular implantable electronic device replacement infections and prevention: results from the REPLACE Registry.
abstract: BACKGROUND
  Infection following cardiovascular implantable electronic device (CIED) replacement is a serious complication, and rates of infection have increased. Analysis of procedural and clinical data from device replacement procedures collected by the REPLACE Registry may provide insights into infection prevention strategies and outcomes.
  
  
  METHODS
  We prospectively evaluated procedural complications in patients undergoing CIED replacement over 6 months from 72 U.S. sites. Major and minor infections were predefined and adjudicated by an independent blinded clinical events committee. Data regarding infection prevention strategies and infectious outcomes were analyzed for their potential relationships.
  
  
  RESULTS
  A total of 1,744 patients were included in REPLACE. All patients received preoperative intravenous antibiotics and 68.7% received postoperative systemic antibiotic therapy. CIED infection developed in 22 patients (1.3%), of which 14 cases were major (0.8%, 95% confidence interval [CI] 0.4%-1.3%) and eight were minor (0.5%, 95% CI 0.2%-0.9%). Patients with infections were more likely to have had postoperative hematomas (five of 22 [22.7%] vs 17 of 1,722 [0.98%], P = 0.002). Participating sites experiencing infection rates >5% were more likely to use povidone-iodine for topical antisepsis, had lower implantation volume, and had patients with higher Charlson Comorbidity Index (2.79 vs 2.32, 95% CI for difference 0.08-0.86, P = 0.019).
  
  
  CONCLUSIONS
  In this multicenter prospective study with 6 months of follow-up, infections associated with CIED replacements were surprisingly infrequent, possibly due to the use of preoperative antibiotics. Patients with infections were more likely to have had a postoperative hematoma, and sites with higher infection rates had sicker patients and lower overall procedural volume.
authors.affiliation: Division of Infectious Diseases, David Geffen School of Medicine at University of California, Los Angeles, California 90095, USA. duslan@mednet.ucla.edu
authors.forename: Daniel Z
authors.initials: DZ
authors.lastname: Uslan
authors.forename: Marye J
authors.initials: MJ
authors.lastname: Gleva
authors.forename: David K
authors.initials: DK
authors.lastname: Warren
authors.forename: Theofanie
authors.initials: T
authors.lastname: Mela
authors.forename: Mina K
authors.initials: MK
authors.lastname: Chung
authors.forename: Venkateshwar
authors.initials: V
authors.lastname: Gottipaty
authors.forename: Richard
authors.initials: R
authors.lastname: Borge
authors.forename: Dan
authors.initials: D
authors.lastname: Dan
authors.forename: Timothy
authors.initials: T
authors.lastname: Shinn
authors.forename: Kevin
authors.initials: K
authors.lastname: Mitchell
authors.forename: Richard G
authors.initials: RG
authors.lastname: Holcomb
authors.forename: Jeanne E
authors.initials: JE
authors.lastname: Poole
mesh_terms: D000368:Aged; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D009205:Myocarditis / Q000453:epidemiology* / Q000517:prevention & control*; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D015995:Prevalence; D016459:Prosthesis-Related Infections / Q000453:epidemiology* / Q000517:prevention & control*; D018570:Risk Assessment; D014481:United States / Q000453:epidemiology