title: Incidence of and risk factors for infectious complications in patients with cardiac device implantation.
abstract: OBJECTIVE
  The use of cardiac implantable electronic device (CIED; pacemakers, implantable cardioverter-defibrillators [ICD], cardiac re-synchronized therapy [CRT]) implantation, one essential treatment for cardiac arrhythmias, is increasing. Infectious complications related to implants are the main reason for device removal and patient morbidity. We sought to identify the incidence of infectious complications among patients with cardiac device implantation and analyze the risk factors for infectious complications.
  
  
  METHODS
  A retrospective analysis was conducted of 1307 patients (61.5±14.2 years-old, 49.6% male) with cardiac device implantation from January 1990 to April 2013. We analyzed the incidence of infectious complications during the follow-up period. To investigate risk factors associated with infectious complications, we conducted a 1:2 matched case-control study of patients with infectious complications and controls without infectious complications who had the same implantation period and physician.
  
  
  RESULTS
  Among 1307 patients, 12 had a confirmed device-related infection: 7 with a pocket infection and 5 with infective endocarditis. Over a total of 9091.9 device-years, the incidence of infectious complications was 1.3/1000 device-years, based on the 12 patients with an infection. ICD (5.1/1000 device-year) had a higher incidence of infectious complications than other cardiac devices, and no infectious complications were observed among patients with CRT implantation. Mean duration from the time of implantation to infection was 2.02±1.65 years. In a multivariate analysis, the number of prior procedures including wound revision or scar revision was an independent risk factor for infectious complications (OR=10.88, 95% CI 1.11->999, p=0.040).
  
  
  CONCLUSIONS
  Infection was a rare complication of cardiac device implantation, but repeated procedures were associated with infectious complications.
authors.affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea; AIDS Research Institute.
authors.forename: Hea Won
authors.initials: HW
authors.lastname: Ann
authors.affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea; AIDS Research Institute.
authors.forename: Jin Young
authors.initials: JY
authors.lastname: Ahn
authors.affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Yong Duk
authors.initials: YD
authors.lastname: Jeon
authors.affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: In Young
authors.initials: IY
authors.lastname: Jung
authors.affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea; AIDS Research Institute.
authors.forename: Su Jin
authors.initials: SJ
authors.lastname: Jeong
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Boyoung
authors.initials: B
authors.lastname: Joung
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: MoonHyoung
authors.initials: M
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea; AIDS Research Institute.
authors.forename: Nam Su
authors.initials: NS
authors.lastname: Ku
authors.affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea; AIDS Research Institute.
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Han
authors.affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea; AIDS Research Institute.
authors.forename: June Myung
authors.initials: JM
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea; AIDS Research Institute. Electronic address: seran@yuhs.ac.
authors.forename: Jun Yong
authors.initials: JY
authors.lastname: Choi
mesh_terms: D000328:Adult; D000368:Aged; D017147:Defibrillators, Implantable; D020878:Device Removal; D004697:Endocarditis, Bacterial / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D016459:Prosthesis-Related Infections / Q000453:epidemiology*; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors
keywords: CIED; CRT; ICD; Pacemaker; infection