title: Increased late complex device infections are determined by cardiac resynchronization therapy-defibrillator infection.
abstract: OBJECTIVE
  The incidence of cardiac device infection (CDI) more than 12 months following complex device implant (late infection) has not been extensively reported. Our objective was to compare both early (within 12 months) and late infection rates following complex device implantation.
  
  
  RESULTS
  Patients who received either a cardiac resynchronization therapy (CRT) device with or without a defibrillator (CRT-D or CRT-P), or a defibrillator alone [implantable cardioverter-defibrillator (ICD)], between March 2005 and December 2011 were studied retrospectively. The study endpoint was device removal due to CDI. A total of 496 patients underwent complex device implantation. There were 1883 patient years of follow-up. Mean age was 73 ± 8 years. Seventy per cent were male. Overall, 24 infections (4.8%) were identified; 6 infections were within 12 months (1.2%) and 18 (3.7%) infections at least 12 months following implant (P < 0.025). The mean intervals between implant and infection were 6 months (±3.7) and 30 months (±14.4) in the early and late groups, respectively. Early infection rates (%) for ICD, CRT-P, and CRT-D devices were 1.5, 1.6, and 0.6, respectively. Corresponding late infection rates were 2.2, 2.1, and 6.4. The increased late infection rate was driven by increased CRT-D infection (P < 0.01; compared with early CRT-D infection).
  
  
  CONCLUSIONS
  Early CDI rates are consistent with published data. Compared with early infection, late CDI rates are significantly increased and are due to CRT-D infection. These findings are consistent with emerging reports. Late CRT-D infection threatens to undermine the long-term costs and overall health gain from these devices.
authors.affiliation: Nephrology Department, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Unsworth
authors.affiliation: Manchester Heart Centre, Manchester Royal Infirmary, Oxford Road, Manchester M13 9W, UK.
authors.forename: Amir
authors.initials: A
authors.lastname: Zaidi
authors.affiliation: Department of Cardiology, Fairfield District General Hospital, Rochdale Old Road, Bury, Lancashire BL9 7TD, UK dr.hargreaves@pat.nhs.uk mrhfrcp@icloud.com.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Hargreaves
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects*; D058409:Cardiac Resynchronization Therapy Devices / Q000009:adverse effects*; D016208:Databases, Factual; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D020878:Device Removal; D004554:Electric Countershock / Q000009:adverse effects* / Q000295:instrumentation; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology* / Q000601:surgery; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Cardiac resynchronization; Defibrillator; Infection