title: Variability in clinical features of early versus late cardiovascular implantable electronic device pocket infections.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington.
authors.forename: Mariko
authors.initials: M
authors.lastname: Welch
authors.forename: Daniel Z
authors.initials: DZ
authors.lastname: Uslan
authors.forename: Arnold J
authors.initials: AJ
authors.lastname: Greenspon
authors.forename: Muhammad R
authors.initials: MR
authors.lastname: Sohail
authors.forename: Larry M
authors.initials: LM
authors.lastname: Baddour
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Blank
authors.forename: Roger G
authors.initials: RG
authors.lastname: Carrillo
authors.forename: Stephan B
authors.initials: SB
authors.lastname: Danik
authors.forename: Ana
authors.initials: A
authors.lastname: Del Rio
authors.forename: Walter
authors.initials: W
authors.lastname: Hellinger
authors.forename: Katherine Y
authors.initials: KY
authors.lastname: Le
authors.forename: Jose M
authors.initials: JM
authors.lastname: Miro
authors.forename: Christoph
authors.initials: C
authors.lastname: Naber
authors.forename: James E
authors.initials: JE
authors.lastname: Peacock
authors.forename: Holenarasipur R
authors.initials: HR
authors.lastname: Vikram
authors.forename: Chi-Hong
authors.initials: CH
authors.lastname: Tseng
authors.forename: Jordan M
authors.initials: JM
authors.lastname: Prutkin
mesh_terms: D000368:Aged; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000175:diagnosis* / Q000209:etiology*; D013997:Time Factors
keywords: cardiac implantable devices; device infection; endocarditis