Risk Factors for Infections of Cardiac Implantable Electronic Device in Saudi Arabia

Abstract

Background and Objectives: Cardiac implantable electronic device (CIED) infections are increasing worldwide due to the increased use of implantable cardiac devices. (CIED) infection is a serious complication that is associated with increased mortality and morbidity as well as increased healthcare costs. However, risk factors for infection of implanted devices are poorly documented in Saudi Arabia. We aimed to determine risk factors for CIED infection in our region. Methods and Results: A retrospective study was carried out in cardiology departments at different centers in Saudi Arabia. Our population consisted of all patients with device-related infections over twenty years from January 2009 to December 2020 with one control case matched to each confirmed infection of the implanted device, resulting in 137 patients with device infection. The mean age was 58±16 years, where males constituted 75.2%. Most infections occurred in patients with the first implant. (63.5%) patients had chronic kidney disease, (59.9%) of patients had diabetes mellitus, (65%) of patients had hypertension, and (43.1%) of patients had coronary artery disease. Most of the patients had a pocket infection. Preop antibiotics were obtained in all patients before implanting. The median time from the last surgical intervention involving the device to infection symptoms was 730 days. The median length of hospitalization was 27±23 days. 130 patients survived at the time of discharge, resulting in an overall mortality rate of 5.1%. Using Multivariate analysis, we identified male gender (P = 0.000), hypertension HTN (P = 0.002), diabetes DM (P = 0.006), and presence of underlying heart disease CHD (P = 0.000) Type of the device (P = 0.000) as significantly associated with a higher risk of CIED infection. Conclusion: Our data show that gender, diabetes, hypertension, and heart disease are independent risk factors for infection after cardiac device implantation. As regards device characteristics, ICD device is associated with a higher infection rate compared to other devices.