Cardiovascular implantable electronic device replacement infections and prevention: Results from the REPLACE registry

Daniel Z. Uslan, Marye J. Gleva, David K. Warren, Theofanie Mela, Mina K. Chung, Venkateshwar Gottipaty, Richard Borge, Dan Dan, Timothy Shinn, Kevin Mitchell, Richard G. Holcomb, Jeanne E. Poole

Research output: Contribution to journalArticlepeer-review

130 Scopus citations

Abstract

Background: Infection following cardiovascular implantable electronic device (CIED) replacement is a serious complication, and rates of infection have increased. Analysis of procedural and clinical data from device replacement procedures collected by the REPLACE Registry may provide insights into infection prevention strategies and outcomes. Methods: We prospectively evaluated procedural complications in patients undergoing CIED replacement over 6 months from 72 U.S. sites. Major and minor infections were predefined and adjudicated by an independent blinded clinical events committee. Data regarding infection prevention strategies and infectious outcomes were analyzed for their potential relationships. Results: A total of 1,744 patients were included in REPLACE. All patients received preoperative intravenous antibiotics and 68.7% received postoperative systemic antibiotic therapy. CIED infection developed in 22 patients (1.3%), of which 14 cases were major (0.8%, 95% confidence interval [CI] 0.4%-1.3%) and eight were minor (0.5%, 95% CI 0.2%-0.9%). Patients with infections were more likely to have had postoperative hematomas (five of 22 [22.7%] vs 17 of 1,722 [0.98%], P = 0.002). Participating sites experiencing infection rates >5% were more likely to use povidone-iodine for topical antisepsis, had lower implantation volume, and had patients with higher Charlson Comorbidity Index (2.79 vs 2.32, 95% CI for difference 0.08-0.86, P = 0.019). Conclusions: In this multicenter prospective study with 6 months of follow-up, infections associated with CIED replacements were surprisingly infrequent, possibly due to the use of preoperative antibiotics. Patients with infections were more likely to have had a postoperative hematoma, and sites with higher infection rates had sicker patients and lower overall procedural volume.

Original languageEnglish
Pages (from-to)81-87
Number of pages7
JournalPACE - Pacing and Clinical Electrophysiology
Volume35
Issue number1
DOIs
StatePublished - Jan 2012

Keywords

  • defibrillator
  • infection
  • pacemaker

Fingerprint

Dive into the research topics of 'Cardiovascular implantable electronic device replacement infections and prevention: Results from the REPLACE registry'. Together they form a unique fingerprint.

Cite this