Risk Factors for Infections Involving Cardiac Implanted Electronic Devices

被引：125

作者：

Birnie, David H. ^{[1
]}

Wang, Jia ^{[2
]}

Alings, Marco ^{[3
]}

Philippon, Francois ^{[4
]}

Parkash, Ratika ^{[5
]}

Manlucu, Jaimie ^{[6
]}

Angaran, Paul ^{[7
]}

Rinne, Claus ^{[8
]}

Coutu, Benoit ^{[9
]}

Low, R. Aaron ^{[10
]}

Essebag, Vidal ^{[11
]}

Morillo, Carlos ^{[12
]}

Redfearn, Damian ^{[13
]}

Toal, Satish ^{[14
]}

Becker, Giuliano ^{[15
]}

Degrace, Michel ^{[16
]}

Thibault, Bernard ^{[17
]}

Crystal, Eugene ^{[18
]}

Tung, Stanley ^{[19
]}

LeMaitre, John ^{[20
]}

Sultan, Omar ^{[21
]}

Bennett, Matthew ^{[21
,22
]}

Bashir, Jamil ^{[23
]}

Ayala-Paredes, Felix ^{[24
]}

Gervais, Philippe ^{[4
]}

Rioux, Leon ^{[25
]}

Hemels, Martin E. W. ^{[26
,27
]}

Bouwels, Leon H. R. ^{[28
]}

Exner, Derek V. ^{[12
]}

Dorian, Paul ^{[7
]}

Connolly, Stuart J. ^{[2
]}

Longtin, Yves ^{[29
]}

Krahn, Andrew D. ^{[23
]}

机构：

[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

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2019年 / 74卷 / 23期

关键词：

antibiotics; cardiac implantable electronic device; implantable cardioverter defibrillator; infection; pacemaker; MANAGEMENT; MORTALITY; PREVENTION; PACEMAKER; TRIAL; TIME;

D O I：

10.1016/j.jacc.2019.09.060

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

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.

引用

页码：2845 / 2854

页数：10

共 23 条

[1]

Anderson DJ, 2014, INFECT CONT HOSP EP, V35, P605, DOI [10.1086/676022, 10.1017/S0899823X00193869]

[2] Update on Cardiovascular Implantable Electronic Device Infections and Their Management A Scientific Statement From the American Heart Association [J].

Baddour, Larry M. ;

Epstein, Andrew E. ;

Erickson, Christopher C. ;

Knight, Bradley P. ;

Levison, Matthew E. ;

Lockhart, Peter B. ;

Masoudi, Frederick A. ;

Okum, Eric J. ;

Wilson, Walter R. ;

Beerman, Lee B. ;

Bolger, Ann F. ;

Estes, N. A. Mark, III ;

Gewitz, Michael ;

Newburger, Jane W. ;

Schron, Eleanor B. ;

Taubert, Kathryn A. .

CIRCULATION, 2010, 121 (03) :458-477

[3] Risk Factors for Mortality in Patients With Cardiac Device-Related Infection [J].

Baman, Timir S. ;

Gupta, Sanjaya K. ;

Valle, Javier A. ;

Yamada, Elina .

CIRCULATION-ARRHYTHMIA AND ELECTROPHYSIOLOGY, 2009, 2 (02) :129-134

[4] Continued vs. interrupted direct oral anticoagulants at the time of device surgery, in patients with moderate to high risk of arterial thrombo-embolic events (BRUISE CONTROL-2) [J].

Birnie, David H. ;

Healey, Jeff S. ;

Wells, George A. ;

Ayala-Paredes, Felix ;

Coutu, Benoit ;

Sumner, Glen L. ;

Becker, Giuliano ;

Verma, Atul ;

Philippon, Franc Comma Ois ;

Kalfon, Eli ;

Eikelboom, John ;

Sandhu, Roopinder K. ;

Nery, Pablo B. ;

Lellouche, Nicholas ;

Connolly, Stuart J. ;

Sapp, John ;

Essebag, Vidal .

EUROPEAN HEART JOURNAL, 2018, 39 (44) :3973-+

[5] Device Surgery without Interruption of Anticoagulation [J].

Golwala, Harsh .

NEW ENGLAND JOURNAL OF MEDICINE, 2013, 369 (16) :1571-1571

[6] Beyond 30 Days: A Risk Calculator for Longer Term Outcomes of Prosthetic Breast Reconstruction [J].

Blough, Jordan T. ;

Vu, Michael M. ;

Qiu, Cecil S. ;

Mlodinow, Alexei S. ;

Khavanin, Nima ;

Fine, Neil A. ;

Kim, John Y. S. .

PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN, 2018, 6 (12)

[7]

Collins GS, 2015, J CLIN EPIDEMIOL, V68, P112, DOI [10.1038/bjc.2014.639, 10.1016/j.jclinepi.2014.11.010, 10.1136/bmj.g7594, 10.7326/M14-0697, 10.7326/M14-0698, 10.1016/j.eururo.2014.11.025, 10.1002/bjs.9736, 10.1186/s12916-014-0241-z]

[8] Randomized Cluster Crossover Trials for Reliable, Efficient, Comparative Effectiveness Testing: Design of the Prevention of Arrhythmia Device Infection Trial (PADIT) [J].