| ObjectiveTo analyze the risk factors and treatment strategy of cardiovascular implantable electronic device (CIED) related infection.MethodsA retrospective review of all patients with CIED related infection admitted in cardiovascular department of the second affiliated hospital of medical school, Zhejiang University from January 1995 to February 2016 was conducted. The baseline clinical data, operative strategies and follow-up data were collected and analyzed to investigated the risk factors of CIED related infection. Comparisons were conducted in concominant diseases, operation times, pocket hematoma, outcomes of different operative strategies, etc.Results60 patients with CIED related infection were included (25 women(41.7%), mean age 66.3±13.4 years). Cultures were positive in 20 patients (33.3%), in 40% of which staphylococcus aureus was detected. The median of CIED related infection occurrence time was 18 months(range from 14 days to 96 months). Among patients studied, early-onset infection(<1 month) was presented in 6(10%) patients, mid-term infection(1～12 months) in 23(38.3%) patients, delayed infection(12-24 months) in 10(16.7%) patients, and late-onset infection(>24 months) in 21(35%) patients. In patients with early-onset infection, the morbidity of CIED infection was significantly increased in women (p=0.037) and patients with pocket hematoma after the implantation(p=0.037). In patients with delayed infection, the morbidity of CIED infection was significantly increased in patients with diabetes mellitus(p=0.020), coronary atherosclerotic heart disease(p=0.007), cardiomyopathy(p=0.020), heart failure(p=0.038), and complex device implanted (including ICD, CRT-P/D)(p=0.021).5 patients (1.2%) with CRT-P/D related infection were included in all patients. Old(p=0.044), cerebral infarction(p=0.042), gout(p<0.001), hypothyroidism(p<0.001) and tumor(p<0.001) were related to CRT related infection statistically.52(86.7%) of all patients presented pocket infection and the other 8(13.3%) presented hematogenous infection. Diabetes mellitus(p=0.047) and hypoproteinemia(p=0.047) significantly increased the morbidity of pocket infection, whereas cardiomyopathy (p=0.007), heart failure(p=0.031) significantly increased the morbidity of hematogenous infection. Pocket debridement, lead amputation and lead extraction were performed in 13(22%), 12(20%),35(58%) patients, respectively. There was no significant difference in operative strategies between pocket infection and hematogenous infection. The average duration of antibiotics therapy was 14.9±8.0 days. Patients with hematogenous infection had longer antibiotics therapy duration than patients with pocket infection[(19.7±10.2) days vs (13.0±6.5) days, p=0.048]. The median follow-up time was 48 months(range from 1 month to 90 months).15 CIED related infection recurred after 1～17months (median 5 months) from onset of anti-infection therapy, and the incidence was 25.0%. Patients with lead extraction had less rate of recurrent infection than both pocket debridement (5.7% vs 46.2%, p=0.013) and lead amputation (5.7% vs 53.8%, p<0.001). A total of 42 patients underwent lead extraction, divided into 2 groups: Surgical group (n=4) and Trans-venous group (n=38). The duration of CIED implantation history [(14.9±4.6)months vs (49.0±44.0)months, p=0.042] and hospitalization [(105.7±48.2)days vs (24.3±8.1)days, p=0.005] in surgical group was significantly longer than that in trans-venous group. No serious complication occurred in either group. There was no statistical difference of success rate or recurrence rate.ConclusionsStaphylococcus aureus is the most common pathogen in CIED related infection patients in our institution. Factors associated with periods of CIED infection are female, complexity of CIED, pocket hematoma, diabetes mellitus, coronary atherosclerotic heart disease, cardiomyopathy and heart failure. Old, cerebral infarction, gout, hypothyroidism and tumor are risk factors in CRT related infection. Diabetes mellitus, hypoproteinemia are risk factors for pocket infection, whereas cardiomyopathy, heart failure are associated with hematogenous infection. Once the CIED infection occurred, lead extraction as well as pulse-generators removal is optimal strategy. CIED lead retraction by trans-venous approach can be effectively performed with less hospital days. |
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