Risk Factors for Infections Involving Cardiac Implanted Electronic Devices Academic Article uri icon

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abstract

  • 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. (Prevention of Arrhythmia Device Infection Trial [PADIT Pilot]; NCT01002911).

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 EW
  • Bouwels, Leon HR
  • Exner, Derek V
  • Dorian, Paul
  • Connolly, Stuart
  • Longtin, Yves
  • Krahn, Andrew D

publication date

  • December 2019

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