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. 2019 Jun 14;40(23):1862-1869.
doi: 10.1093/eurheartj/ehz316.

Incidence of device-related infection in 97 750 patients: clinical data from the complete Danish device-cohort (1982-2018)

Thomas Olsen  1 , Ole Dan Jørgensen  2   3 , Jens Cosedis Nielsen  3   4 , Anna Margrethe Thøgersen  5 , Berit Thornvig Philbert  6 , Jens Brock Johansen  1   3
Affiliations

Incidence of device-related infection in 97 750 patients: clinical data from the complete Danish device-cohort (1982-2018)

Thomas Olsen et al. Eur Heart J. .

Abstract

Aims: Device-related infection (DRI) is a severe complication to cardiac implantable electronic devices (CIED) therapy. Device-related infection incidence and its risk factors differ between previous studies. We aimed to define the long-term incidence and incidence rates of DRI for different types of CIEDs in the complete Danish device-cohort and identify patient-, operation- and device-related risk factors for DRI.

Methods and results: From the Danish Pacemaker (PM) and implantable cardioverter-defibrillator (ICD) Register, we included consecutive Danish patients undergoing CIED implantation or reoperation from January 1982 to April 2018, resulting in 97 750 patients, 128 045 operations and follow-up of in total 566 275 device years (DY). We identified 1827 DRI causing device removals. Device-related infection incidence during device lifetime was 1.19% (1.12-1.26) for PM, 1.91% (1.71-2.13) for ICD, 2.18% (1.78-2.64) for cardiac resynchronization therapy (CRT)-pacemakers (CRT-P), and 3.35% (2.92-3.83) for CRT-defibrillators (CRT-D). Incidence rates in de novo implantations were 2.04/1000 DY for PM, 3.84 for ICD, 4.38 for CRT-P, and 6.76 for CRT-D. Using multiple-record and multiple-event per subject proportional hazard analysis, we identified implantation of complex devices (ICD and CRT), reoperations, prior DRI, male sex, and younger age as significantly associated with higher DRI risk.

Conclusion: Overall risk of infection was low in PM implantations but considerably higher in CRT systems and after reinterventions. These data support the importance of evaluating all patients considered for CIED therapy thoroughly, in order to identify potential modifiable risk factors and reduce the risk of early reoperations.

Keywords: CIED; CRT; Device; ICD; Incidence; Infection; Pacemaker.

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Figures

Figure 1
Figure 1
(A) Kaplan–Meier curve of the time to infection after de novo implant in different types of devices in the Danish CIED population, 1982–2018, n = 97 732. (B) The first 120 days after implantation. (C) Enlarged portion of (A).
Figure 2
Figure 2
Cumulative incidence function with death as competing risk of the time to first infection in different device types after first implants (Fi) and replacement (Re) operations. The competing risk analysis is adjusted for sex, age, year of implantation, centre, and complexity (number of hardware pieces implanted and removed during the same operation).
Take home figure
Take home figure
Cumulative lifetime risk of device-related infection in different types of devices in the Danish CIED population, 1982–2018, n = 97 750.
None
See this image and copyright information in PMC

Comment in

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