Author + information
- Faisal F. Syed,
- Paul Friedman,
- Samuel Asirvatham,
- Larry Baddour,
- James Steckelberg,
- Christine Lohse,
- Walter Wilson and
- Muhammad Sohail
Ln-vitro studies of microbial biofilm formation suggest that medical device size and surface characteristics influence whether microbes can adhere to and colonize them. Whether these factors influence risk of cardiac device infection is unknown.
We conducted a case-control study of permanent pacemaker (PPM) infection treated at our institution over 18 years. Each infected case was matched with 2 un-infected controls by age at implant, sex, year of implant and follow-up duration. Epicardial, resynchronization and defibrillator systems were excluded. Pulse generator volume (PGV) and lead insulation material (polyurethane [P] vs silicone [S]) were determined from manufacturer specifications. PGV, lead insulation material, lead number and presence of abandoned leads, history of prior device manipulation, and host factors were evaluated using conditional logistic regression models to assess associated risk of PPM infection.
Forty-nine cases of PPM infection (age [mean ± SD] 66 ± 16 years) were matched to 98 controls (67 ± 16 years). The majority (70%) of infections were due to staphylococcal species. An association between PGV and risk of device infection was of borderline significance (OR per ml 1.13 [1.00–1.29], p=0.056). Lead insulation material was not associated with risk of infection (P vs S: OR 0.87, p=0.79). The presence of >2 leads (OR 9.00 (1.95–41.7] p=0.005) and an abandoned lead (OR 10.0 [2.19–45.6], p=0.003) were associated with increased risk of infection. Infection risk was also increased in patients with renal disease (OR 3.34 [1.32–8.47], p=0.011) and >1 prior device-related procedure (OR 9.05 (2.60–31.5), p<0.001). Only renal disease and >1 prior device-related procedure remained significantly associated with infection risk on multivariable analysis.
Renal disease and multiple prior device-related procedures are associated with increased risk of PPM infection. Although prosthesis burden (generator volume, number of leads and presence of abandoned leads) was significant in univariate analysis, an independent effect on infection risk was not found. Lead insulation material was not associated with risk of infection.
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Arrhythmias: Devices I – Identification and Avoidance of Complications Associated with Implantable Devices
Abstract Category: 8. Arrhythmias: Devices
Presentation Number: 1149-31
- 2013 American College of Cardiology Foundation