Cardiac implantable electronic device infections: Who is at greatest risk?

Abstract

Cardiac implantable electronic device (CIED) infections are associated with hospitalization, mortality, increased costs, and adverse outcomes. Determine the burden of infections for CIEDs based on device type, associated comorbidities, and clinical characteristics over a 12-year period. Utilizing data from the National Inpatient Sample database for cases from 2000 through 2012, we identified procedures for device-related infection (DRI) using International Statistical Classification of Diseases and Related Health Problems, Ninth Revision, Clinical Modification (ICD-9-CM) codes for CIED removal with diagnosis codes for device-related infection or systemic infection. Cases were categorized into 4 groups: single-chamber pacemaker, dual-chamber pacemaker, cardiac resynchronization therapy (CRT) device, and intracardiac defibrillator (ICD). Of 4,144,683 device-related procedures, 85,203 (2.06%) were associated with DRI. From 2000 through 2012, procedures related to DRI increased from 1.45% to 3.41% (P < .001). The risk of infection for CRT devices was the highest, peaking in 2012 (adjusted odds ratio [OR] 2.43, P < .001). During second half of the study, comorbidities associated with DRI were diabetes (OR: 1.11, P < .001), end-stage renal disease (OR: 3.23, P<.001), hematoma (OR: 2.44, P < .001), malnutrition (OR: 2.66, P < .001), venous thromboembolism (OR: 2.37, P < .001), chronic kidney disease (OR: 1.26, P < .001), and organ transplantation (OR: 2.37, P < .001). Charges associated with CRT DRIs increased nearly 2-fold in a decade. Higher inpatient mortality related to device infection were stroke (OR: 3.19, P < .001), end-stage renal disease (OR: 2.91, P < .001), malnutrition (OR: 2.67, P < .001), cirrhosis (OR: 2.05, P = .001), and organ transplantation (OR: 2.16, P < .001). CIED infections are increasing for all device types and particularly for CRT devices. Precise reasons for rising DRI procedures remain unclear, although conditions leading to immune compromise appear significant.