Risk Factors for Infections Involving Cardiac Implanted Electronic Devices

Cardiac implantable electronic device infection is a major complication that usually requires device removal. PADIT (Prevention of Arrhythmia Device Infection Trial) was a large cluster crossover trial of conventional versus incremental antibiotics. This study sought to investigate independent predi...

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Published in:Journal of the American College of Cardiology Vol. 74; no. 23; p. 2845
Main Authors: Birnie, David H, Wang, Jia, Alings, Marco, Philippon, François, Parkash, Ratika, Manlucu, Jaimie, Angaran, Paul, Rinne, Claus, Coutu, Benoit, Low, R Aaron, Essebag, Vidal, Morillo, Carlos, Redfearn, Damian, Toal, Satish, Becker, Giuliano, Degrâce, Michel, Thibault, Bernard, Crystal, Eugene, Tung, Stanley, LeMaitre, John, Sultan, Omar, Bennett, Matthew, Bashir, Jamil, Ayala-Paredes, Felix, Gervais, Philippe, Rioux, Leon, Hemels, Martin E W, Bouwels, Leon H R, Exner, Derek V, Dorian, Paul, Connolly, Stuart J, Longtin, Yves, Krahn, Andrew D
Format: Journal Article
Language:English
Published: United States 10.12.2019
Subjects:
Aged
Antibiotic Prophylaxis - methods
Arrhythmias, Cardiac - therapy
Canada - epidemiology
Cross-Over Studies
Defibrillators, Implantable - adverse effects
Female
Hospitalization - statistics & numerical data
Humans
Incidence
Male
Pacemaker, Artificial - adverse effects
Prosthesis-Related Infections - epidemiology
Prosthesis-Related Infections - prevention & control
Risk Assessment - methods
Risk Factors
Canada
implantable cardioverter defibrillator
infection
pacemaker
antibiotics
cardiac implantable electronic device
ISSN:1558-3597, 1558-3597
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Summary:Cardiac implantable electronic device infection is a major complication that usually requires device removal. PADIT (Prevention of Arrhythmia Device Infection Trial) was a large cluster crossover trial of conventional versus incremental antibiotics. This study sought to investigate independent predictors of device infection in PADIT and develop a novel infection risk score. In brief, over 4 6-month periods, 28 centers used either conventional or incremental prophylactic antibiotic treatment in all patients. The primary outcome was hospitalization for device infection within 1 year (blinded endpoint adjudication). Multivariable logistic prediction modeling was used to identify the independent predictors and develop a risk score for device infection. The prediction models were internally validated with bootstrap methods. Device procedures were performed in 19,603 patients, and hospitalization for infection occurred in 177 (0.90%) within 1 year of follow-up. The final prediction model identified 5 independent predictors of device infection (prior procedures [P], age [A], depressed renal function [D], immunocompromised [I], and procedure type [T]) with an optimism-corrected C-statistic of 0.704 (95% confidence interval: 0.660 to 0.744). A PADIT risk score ranging from 0 to 15 points classified patients into low (0 to 4), intermediate (5 to 6) and high (≥7) risk groups with rates of hospitalization for infection of 0.51%, 1.42%, and 3.41%, respectively. This study identified 5 independent predictors of device infection and developed a novel infection risk score in the largest cardiac implantable electronic device trial to date, warranting validation in an independent cohort. The 5 independent predictors in the PADIT score are readily adopted into clinical practice. (Prevention of Arrhythmia Device Infection Trial [PADIT Pilot]; NCT01002911).
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ISSN:1558-3597
1558-3597
DOI:10.1016/j.jacc.2019.09.060