title: Cardiac implantable electronic device infection in patients with end-stage renal disease.
abstract: BACKGROUND
  Cardiac implantable electronic devices (CIED) are increasingly being used in end-stage renal disease (ESRD) patients. These patients have a high risk of device infection.
  
  
  OBJECTIVE
  To study the optimal management of device infections in patients with ESRD.
  
  
  METHODS
  We used the United States Renal Data System (USRDS) to assess the presence of a CIED and associated comorbidities, risk factors for infection, and mortality following device extraction or medical management in ESRD patients with CIED infection. Univariable, multivariable, and survival analyses were performed using USRDS data from 2005 to 2009.
  
  
  RESULTS
  Of 546,769 patients, 6.4% had CIED and 8.0% of those developed CIED infection. The major risk factors for device infection were black race, temporary dialysis catheter, and body mass index >25. Patients with artificial valves were excluded from the analysis. Only 28.4% of infected CIED were removed. CIED removal was more common in those with congestive heart failure. The median time to death following diagnosis of a CIED infection was 15.7 months versus 9.2 months for those treated via device extraction versus medical-only therapy (hazard ratio: 0.75; 95% confidence interval: 0.68-0.82).
  
  
  CONCLUSIONS
  Patients with ESRD and infected CIEDs have a poor prognosis. Rates of device extraction are low, but this strategy appears to be associated with modest improvement in survival.
authors.affiliation: Department of Medicine, Georgia Regents University, Augusta, Georgia. Electronic address: aguha@gru.edu.
authors.forename: Avirup
authors.initials: A
authors.lastname: Guha
authors.affiliation: Department of Medicine, Georgia Regents University, Augusta, Georgia.
authors.forename: William R
authors.initials: WR
authors.lastname: Maddox
authors.affiliation: Department of Medicine, Georgia Regents University, Augusta, Georgia.
authors.forename: Rhonda
authors.initials: R
authors.lastname: Colombo
authors.affiliation: Department of Medicine, Georgia Regents University, Augusta, Georgia; Charlie Norwood VAMC, Augusta, Georgia.
authors.forename: N Stanley
authors.initials: NS
authors.lastname: Nahman
authors.affiliation: Department of Medicine, Georgia Regents University, Augusta, Georgia.
authors.forename: Kristina W
authors.initials: KW
authors.lastname: Kintziger
authors.affiliation: Department of Medicine, Georgia Regents University, Augusta, Georgia.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Waller
authors.affiliation: Department of Medicine, Georgia Regents University, Augusta, Georgia.
authors.forename: Matthew
authors.initials: M
authors.lastname: Diamond
authors.affiliation: Department of Medicine, Georgia Regents University, Augusta, Georgia.
authors.forename: Michele
authors.initials: M
authors.lastname: Murphy
authors.affiliation: Department of Medicine, Georgia Regents University, Augusta, Georgia; Southwest Georgia Nephrology Clinic, PC, Albany, Georgia.
authors.forename: Mufaddal
authors.initials: M
authors.lastname: Kheda
authors.affiliation: Department of Medicine, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Sheldon E
authors.initials: SE
authors.lastname: Litwin
authors.affiliation: Department of Medicine, Georgia Regents University, Augusta, Georgia.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Sorrentino
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016208:Databases, Factual; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D020878:Device Removal; D005260:Female; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D015995:Prevalence; D016459:Prosthesis-Related Infections / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Device extraction; Implanted cardioverter-defibrillator; Infection; Pacemaker