Differences of Mortality Rates between Pocket and Nonpocket Cardiovascular Implantable Electronic Device Infections.
BACKGROUND
A steady rise in the use of cardiovascular implantable electronic devices (CIEDs), particularly in the elderly, has led to an increase in device-related infections. Although often studied and reported as a single entity, these complications in fact comprise a heterogeneous group. Specific subgroups may be associated with distinct mortality risks.


METHODS
Medical records of all patients who underwent device extraction for CIED-related infection at a single tertiary referral center between 1991 and 2007 were reviewed. Infections were divided into four subgroups: primary pocket site infection (PPSI), pocket site infection with bacteremia, primary/isolated bacteremia (PIB), and device-related infective endocarditis (DRIE). Clinical presentation, laboratory data, and mortality rates were obtained by chart review and by querying the Social Security Death Index.


RESULTS
A total of 387 cases were analyzed. The overall in-hospital and 1-year all-cause mortality rates were 7.2% and 25.3%, respectively. Patients with PIB or DRIE had significantly higher mortality rates (hazard ratio [HR] 2.3; 95% confidence interval [CI] 1.2-4.6 and HR 2.5; 95% CI 1.6-4.1, respectively) when compared with patients in the PPSI group. Patients who did not receive a new device during the initial admission also had a higher 1-year mortality rate compared to those who did (HR 2.7; 95% CI 1.8-4.1).


CONCLUSIONS
Our patients with CIED-related infections requiring extraction/hospitalization had a significant mortality risk. Presence of pocket site infection carried a more favorable prognosis, regardless of the presence of bacteremia. Early detection and prevention of CIED-related infections with PIB (i.e., no pocket site involvement), especially for high-risk populations, is needed.
Division of Infectious Diseases and HIV Medicine, Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania.
Dong Heun
DH
Lee
Department of Epidemiology and Biostatistics, Drexel University College of Medicine, Philadelphia, Pennsylvania.
Edward J
EJ
Gracely
Department of Medicine, Nazareth Hospital, Philadelphia, Pennsylvania.
Sarah Y
SY
Aleem
Division of Cardiology, Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania.
Steven P
SP
Kutalek
Division of Infectious Diseases and HIV Medicine, Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania.|Division of Infectious Diseases, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medical College, New York, New York.
Ole
O
Vielemeyer
D017677:Age Distribution; D016470:Bacteremia / Q000401:mortality*; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D004867:Equipment Design; D004868:Equipment Failure / Q000706:statistics & numerical data*; D019544:Equipment Failure Analysis; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D015143:Philadelphia / Q000453:epidemiology; D016459:Prosthesis-Related Infections / Q000401:mortality*; D018570:Risk Assessment / Q000379:methods; D017678:Sex Distribution; D015996:Survival Rate
bacteremia; defibrillator; pace12748maker; retrospective study