Abstract 18511: Early Re-Implantation After Infected Device Extraction is Safe, Reduces Length of Stay and is Not Associated With a Higher Rate of Reinfection
Introduction: Cardiac implantable electronic device (CIED) infection often necessitates complete system removal (CSR) and eventual reimplantation. Concern for reinfection and other complication can delay reimplantation. We evaluated whether early reimplantation is safer, reduces length of stay (LOS) and predisposes to a higher reinfection rate than late reimplantation in patients undergoing CSR for CIED infection.
Methods: We retrospectively reviewed data in 220 patients with CIED infection requiring CSR from 1995-2013 at a single academic medical center. We compared the incidence of major complications, wound dehiscence, and reinfection in patients undergoing early (≤ 48 hours) versus delayed (> 48 hours) reimplantation. A subgroup analysis in multi-drug resistant organism (MDRO) infections was performed.
Results: A total of 97 patients were included. There were 43 patients reimplanted within 48 hours (88.4% men, mean age 69.0 yrs) and 54 patients reimplanted after 48 hours (77.8% men, mean age 65.1 yrs). There were more patients with initial systemic versus local infection in the delayed group (58.6% vs. 18.6%, p=0.0002). Reinfection after early reimplantation was not associated with a systemic presentation (40% vs. 50%, p=0.81). Early reimplantation did not portend a higher risk of major complications (4 vs. 1, p=0.10), wound dehiscence (1 vs. 0, p=0.26) or reinfection (5 vs.2, p=0.13). The findings were similar in early (n=18) versus delayed (n=19) reimplantation in patients with MDRO-positive infections (major complications: 2 vs.1, p=0.52, dehiscence: 0 vs.0, reinfection: 1 vs.1, p=0.97). Early reimplantation was associated with shorter hospital stay than delayed reimplantation (9.3 vs. 16.3 days, p=0.0005).
Conclusions: In patients with CIED infection who have undergone CSR, including those with MDRO infections, early device reimplantation within 48 hours is safe, is not associated with a higher reinfection rate and reduces hospital LOS.
- © 2013 by American Heart Association, Inc.