Risk Factors for Infections Involving Cardiac Implanted Electronic Devices

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:74

Article

Birnie, David H.¹  Wang, Jia²  Alings, Marco³  Philippon, Francois⁴  Parkash, Ratika⁵  Manlucu, Jaimie⁶  Angaran, Paul⁷  Rinne, Claus⁸  Coutu, Benoit⁹  Low, R. Aaron¹⁰  Essebag, Vidal¹¹  Morillo, Carlos¹²  Redfearn, Damian¹³  Toal, Satish¹⁴  Becker, Giuliano¹⁵  Degrace, Michel¹⁶  Thibault, Bernard¹⁷  Crystal, Eugene¹⁸  Tung, Stanley¹⁹  LeMaitre, John²⁰  Sultan, Omar²¹  Bennett, Matthew^21,22  Bashir, Jamil²³  Ayala-Paredes, Felix²⁴  Gervais, Philippe⁴  Rioux, Leon²⁵  Hemels, Martin E. W.^26,27  Bouwels, Leon H. R.²⁸  Exner, Derek V.¹²  Dorian, Paul⁷  Connolly, Stuart J.²  Longtin, Yves²⁹  Krahn, Andrew D.²³ 

[1] Univ Ottawa, Inst Heart, Ottawa, ON, Canada

[2] McMaster Univ, Hamilton Hlth Sci, Populat Hlth Res Inst, Hamilton, ON, Canada

[3] Amphia Ziekenhuis & Working Grp Cardiovasc Res Ne, Breda, Netherlands

[4] Laval Univ, Inst Univ Cardiol & Pneumol Quebec, Quebec City, PQ, Canada

[5] Queen Elizabeth 2 Hlth Sci Ctr, Halifax, NS, Canada

[6] Western Univ, London Hlth Sci, Lawson Hlth Res Inst, London, ON, Canada

[7] Univ Toronto, St Michael Hosp, Div Cardiol, Dept Med, Toronto, ON, Canada

[8] St Marys Gen Hosp, Kitchener, ON, Canada

[9] Univ Montreal, Ctr Hosp Univ Montreal, Montreal, PQ, Canada

[10] Chinook Reg Hosp, Lethbridge, AB, Canada

[11] McGill Univ, Ctr Hlth, Montreal, PQ, Canada

[12] Univ Calgary, Libin Cardiovasc Inst Alberta, Calgary, AB, Canada

[13] Queens Univ, Kingston Gen Hosp, Kingston, ON, Canada

[14] Horizon Hlth Network, St John, NB, Canada

[15] Univ Montreal, Hop Sacre Coeur Montreal, Montreal, PQ, Canada

[16] Hotel Dieu Levis, Levis, PQ, Canada

[17] Montreal Heart Inst, Montreal, PQ, Canada

[18] Sunnybrook Hlth Sci Ctr, Toronto, ON, Canada

[19] Univ British Columbia, St Pauls Hosp, Vancouver, BC, Canada

[20] Royal Columbian Hosp, New Westminster, BC, Canada

[21] Saskatchewan Hlth Author, Regina Gen Hosp, Regina, SK, Canada

[22] Univ British Columbia, Vancouver Gen Hosp, Vancouver, BC, Canada

[23] Univ British Columbia, Vancouver, BC, Canada

[24] Ctr Hosp Univ Sherbrooke, Sherbrooke, PQ, Canada

[25] Ctr Sante & Serv Sociaux Rimouski Neigette, Rimouski, PQ, Canada

[26] Rijnstate Hosp, Arnhem, Netherlands

[27] Radboud Univ Nijmegen, Med Ctr, Nijmegen, Netherlands

[28] Canisius Wilhelmina Ziekenhuis, Nijmegen, Netherlands

[29] McGill Univ, Jewish Gen Hosp Sir Mortimer B Davis, Montreal, PQ, Canada

关键词: antibiotics;    cardiac implantable electronic device;    implantable cardioverter defibrillator;    infection;    pacemaker;   

DOI  :  10.1016/j.jacc.2019.09.060

来源: Elsevier

【 摘 要 】

BACKGROUND 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. OBJECTIVES This study sought to investigate independent predictors of device infection in PADIT and develop a novel infection risk score. METHODS 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. RESULTS 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. CONCLUSIONS 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. (C) 2019 Published by Elsevier on behalf of the American College of Cardiology Foundation.

【 授权许可】

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