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. 2018 Sep 27;34(6):632-639.
doi: 10.1002/joa3.12123. eCollection 2018 Dec.

Cardiac implantable electronic device infection in the cardiac referral center in Thailand: incidence, microbiology, risk factors, and outcomes

Theerawat Korkerdsup  1 , Tachapong Ngarmukos  1 , Somnuek Sungkanuparph  2 , Angsana Phuphuakrat  1
Affiliations

Cardiac implantable electronic device infection in the cardiac referral center in Thailand: incidence, microbiology, risk factors, and outcomes

Theerawat Korkerdsup et al. J Arrhythm. .

Abstract

Background: Despite the long experience of cardiac implantable electronic device (CIED) implantation in Thailand, epidemiology of CIED infection in Thailand has never been studied.

Methods: A retrospective cohort study was conducted at the cardiac referral center in Thailand to investigate incidence of CIED infection and causative organisms between October 2002 and December 2017. A matched case-control study was performed to determine the factors associated with CIED infection.

Results: Incidence of CIED infection was 0.9% with a stable trend during the studied period. There were 54 episodes of CIED infection. The median (interquartile range) age of the patients was 67.5 (53.0-75.0) years. A total of 29 (53.7%), 18 (33.3%), and 7 (13.0%) were permanent pacemaker, automatic implantable cardioverter-defibrillator, and cardio-resynchronization therapy-related infection, respectively. Gram-positive cocci were the most common organism (24 episodes, 44.4%). Gram-negative bacilli were isolated in six episodes (11.1%). About 9.3% were polymicrobial and 35.2% were culture negative. Multivariate analysis showed that previous CIED infection and generator revision procedure were associated with CIED infection (odds ratio [OR] 48.56, 95% confidence interval [CI] 3.72-633.62; P = 0.003 and OR 19.99, 95% CI 1.28-333.24; P = 0.033 respectively). Forty (74.1%) cases were cured. Leaving device in situ was the only factor significantly associated with poor outcome (OR 11.40, 95% CI 1.52-85.73; P = 0.018).

Conclusions: In Thailand, while CIED implantation is rising, incidence of CIED infection is stable. Microbiology of CIED infection in Thailand is similar to western countries, albeit a higher proportion of negative culture. Previous CIED infection and generator revision procedure are associated with CIED infection.

Keywords: Thailand; cardiac implantable electronic device infection; microbiology; risk factors; treatment outcome.

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Figures

Figure 1
Figure 1
Annual number of CIED implantation in Ramathibodi Hospital
Figure 2
Figure 2
Incidence of CIED infection comparing to annual number of CIED implantation
Figure 3
Figure 3
Microbiology of CIED infection (n = 54). CoNS, coagulase‐negative Staphylococcus; MRSA, methicillin‐resistant Staphylococcus aureus; MSSA, methicillin‐susceptible Staphylococcus aureus
See this image and copyright information in PMC

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