Abstract 13539: Variability in Clinical Features of Early Versus Late Cardiovascular Implantable Electronic Device Pocket Infections
Introduction: It is thought that the development of cardiovascular implantable electronic device (CIED) pocket infections is usually related to recent CIED placement or manipulation. The clinical presentation of CIED pocket infection, based on temporal onset related to last CIED procedure, deserves further study.
Methods: The Multicenter Electrophysiologic Device Infection Cohort (MEDIC) prospectively enrolled subjects with CIED infection. All subjects with pocket infection, defined by pocket signs or symptoms, CIED erosion, or presence of a positive culture of pocket tissue, were included. Subjects were stratified into those whose infection occurred <1 year (early) or >1 year (late) since last CIED-related procedure.
Results: There were 127 subjects in the early infection group and 94 in the late infection group. There were no differences in age, race, CIED type, hemodialysis or Charlson Comorbidity Index between groups. There were more females (25% vs. 13%, p = 0.03) and oral anticoagulation use (41% vs. 25%, p = 0.01) in the early group. Subjects with early infections were more likely to have had a generator change or lead addition as last procedure (70.9% vs. 55.3%, p=0.02) and a history of more CIED procedures (2.2 ± 1.3 vs. 1.8± 0.9, p=0.01). Early infections were more likely to present with pocket erythema (79% vs. 52%, p<0.001), swelling (68% vs. 43%, p<0.001), and pain (70% vs. 53%, p=0.005). Late infections were more likely to have pocket erosion (24% vs. 43%, p=0.001), valvular vegetations (18% vs. 6%, p= 0.008) and non-staphylococcal species (26% vs. 14%, p= 0.05). In bacteremic subjects, early infections were more likely to be nosocomial or healthcare associated (68.6% vs. 17.6%, <0.001). In-hospital mortality was equivalent in both groups (3.1% early vs. 2.2% late, p=1.0).
Conclusion: In this multi-center study, over 40% of patients with CIED pocket infection presented > 1 year following their last CIED-related procedure. Subjects with early infection were more likely to be female, on anticoagulation, and present with signs of localized inflammation, while those with late infection were more likely to have CIED erosion or valvular endocarditis. CIED pocket infections may present as indolent infections several years following a procedure.
- © 2012 by American Heart Association, Inc.