title: Rates of and factors associated with infection in 200 909 Medicare implantable cardioverter-defibrillator implants: results from the National Cardiovascular Data Registry.
abstract: BACKGROUND
  The rate of implantable cardioverter-defibrillator (ICD) infections has been increasing faster than that of implantation. We sought to determine the rate and predictors of ICD infection in a large cohort of Medicare patients.
  
  
  RESULTS
  Cases submitted to the ICD Registry from 2006 to 2009 were matched to Medicare fee-for-service claims data using indirect patient identifiers. ICD infections occurring within 6 months of hospital discharge after implantation were identified by ICD-9 codes. Logistic regression was used to examine factors associated with risk of ICD infection. Of 200 909 implants, 3390 patients (1.7%) developed an ICD infection. The infection rate was 1.4%, 1.5%, and 2.0% for single, dual, and biventricular ICDs, respectively (P<0.001). Generator replacement had a higher rate compared with initial implant (1.9% versus 1.6%, P<0.001). The factors associated with infection were adverse event during implant requiring reintervention (odds ratio [OR], 2.692; 95% confidence interval [CI], 2.304-3.145), previous valvular surgery (OR, 1.525; 95% CI, 1.375-1.692), reimplantation for device upgrade, malfunction, or manufacturer advisory (OR, 1.354; 95% CI, 1.196-1.533), renal failure on dialysis (OR, 1.342; 95% CI, 1.123-1.604), chronic lung disease (OR, 1.215; 95% CI, 1.125-1.312), cerebrovascular disease (OR, 1.172; 95% CI, 1.076-1.276), and warfarin (OR, 1.155; 95% CI, 1.060-1.257).
  
  
  CONCLUSIONS
  Patients who developed an ICD infection were more likely to have had peri-ICD implant complications requiring early reintervention, previous valve surgery, device replacement for reasons other than battery depletion, and increased comorbidity burden. Efforts should be made to carefully consider when to reenter the pocket at any time other than battery replacement.
authors: From the University of Washington, Seattle, WA (J.M.P.); Lahey Clinic Medical Center, Burlington, MA (M.R.R.); Yale University, New Haven, CT (H.B., J.P.C.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (S.M.A.); Chicago Medical School, North Chicago, IL (S.A.); and the David Geffen School of Medicine at UCLA, Los Angeles, CA (D.Z.U.). jprutkin@cardiology.washington.edu.
authors: Jordan M
authors: JM
authors: Prutkin
authors: From the University of Washington, Seattle, WA (J.M.P.); Lahey Clinic Medical Center, Burlington, MA (M.R.R.); Yale University, New Haven, CT (H.B., J.P.C.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (S.M.A.); Chicago Medical School, North Chicago, IL (S.A.); and the David Geffen School of Medicine at UCLA, Los Angeles, CA (D.Z.U.).
authors: Matthew R
authors: MR
authors: Reynolds
authors: From the University of Washington, Seattle, WA (J.M.P.); Lahey Clinic Medical Center, Burlington, MA (M.R.R.); Yale University, New Haven, CT (H.B., J.P.C.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (S.M.A.); Chicago Medical School, North Chicago, IL (S.A.); and the David Geffen School of Medicine at UCLA, Los Angeles, CA (D.Z.U.).
authors: Haikun
authors: H
authors: Bao
authors: From the University of Washington, Seattle, WA (J.M.P.); Lahey Clinic Medical Center, Burlington, MA (M.R.R.); Yale University, New Haven, CT (H.B., J.P.C.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (S.M.A.); Chicago Medical School, North Chicago, IL (S.A.); and the David Geffen School of Medicine at UCLA, Los Angeles, CA (D.Z.U.).
authors: Jeptha P
authors: JP
authors: Curtis
authors: From the University of Washington, Seattle, WA (J.M.P.); Lahey Clinic Medical Center, Burlington, MA (M.R.R.); Yale University, New Haven, CT (H.B., J.P.C.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (S.M.A.); Chicago Medical School, North Chicago, IL (S.A.); and the David Geffen School of Medicine at UCLA, Los Angeles, CA (D.Z.U.).
authors: Sana M
authors: SM
authors: Al-Khatib
authors: From the University of Washington, Seattle, WA (J.M.P.); Lahey Clinic Medical Center, Burlington, MA (M.R.R.); Yale University, New Haven, CT (H.B., J.P.C.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (S.M.A.); Chicago Medical School, North Chicago, IL (S.A.); and the David Geffen School of Medicine at UCLA, Los Angeles, CA (D.Z.U.).
authors: Saurabh
authors: S
authors: Aggarwal
authors: From the University of Washington, Seattle, WA (J.M.P.); Lahey Clinic Medical Center, Burlington, MA (M.R.R.); Yale University, New Haven, CT (H.B., J.P.C.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (S.M.A.); Chicago Medical School, North Chicago, IL (S.A.); and the David Geffen School of Medicine at UCLA, Los Angeles, CA (D.Z.U.).
authors: Daniel Z
authors: DZ
authors: Uslan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000453:epidemiology*; D002561:Cerebrovascular Disorders / Q000150:complications; D015331:Cohort Studies; D017147:Defibrillators, Implantable / Q000382:microbiology* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008171:Lung Diseases / Q000150:complications; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D012042:Registries; D051437:Renal Insufficiency / Q000150:complications; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
keywords: implantable cardioverter-defibrillators; infection; infective endocarditis; registries; risk factors