Division of Cardiology, Shimane Prefectural Central Hospital, Izumo, Japan.
Division of Cardiology, Shimane Prefectural Central Hospital, Izumo, Japan.
J Cardiol. 2020 Jul;76(1):115-122. doi: 10.1016/j.jjcc.2020.01.006. Epub 2020 Feb 7.
The incidence of cardiac implantable electronic device (CIED) infection is increasing worldwide. However, data regarding this phenomenon in Japan and information on factors associated with developing CIED infection are limited. Our aim was to compare the incidence of CIED infection between pre-current (past 10-20 years) and current (past 10 years) clinical settings and to investigate risk factors for CIED infection in current clinical settings in a Japanese population.
This observational study included 1749 patients (age 77 ± 12 years, 824 males) who underwent a CIED-related procedure between August 1999 and July 2019 at our institution. We defined the pre-current and current clinical setting periods as August 1999-July 2009 (period I) and August 2009-July 2019 (period II), respectively. We compared the incidence rate of CIED infection between periods and evaluated the risk factors for CIED infection in period II by multivariate analysis.
A CIED infection was identified in 0.7% (5/709 patients) and 1.7% (17/1040) of patients in periods I and II, respectively. Notably, the rate of late (>6 months since last procedure) CIED infection was significantly increased in period II (1.3% vs. 0.1%, p < 0.01), despite the rate of early infection (≤6 months) being comparable (0.4% vs. 0.6%, p = 0.58). On multiple logistic regression, revision [odds ratio (95% confidence interval): 5.2 (1.6-16.3), p = 0.005] and age [0.96, (0.93-0.99), p = 0.007] were identified as independent risk factors for CIED infection in period II.
Our findings suggest that the increasing incidence of CIED infection in current clinical settings was due to an increase in late CIED infection. Furthermore, revision and younger age were identified as independent risk factors for CIED infection in current clinical settings. Our data indicate that clinicians should consider whether the merit of a procedure can overcome the risk of infection when planning revision or implantation in younger patients.
心脏植入式电子设备（CIED）感染的发生率在全球范围内呈上升趋势。然而，有关日本这一现象的数据以及与 CIED 感染相关的因素信息有限。我们的目的是比较日本人群中当前（过去 10 年）和既往（过去 10-20 年）临床环境下 CIED 感染的发生率，并探讨当前临床环境下 CIED 感染的危险因素。
本观察性研究纳入了 1749 例于 1999 年 8 月至 2019 年 7 月在我院行 CIED 相关手术的患者（年龄 77±12 岁，824 例男性）。我们将既往和当前临床环境定义为 1999 年 8 月至 2009 年 7 月（时期 I）和 2009 年 8 月至 2019 年 7 月（时期 II）。我们比较了两个时期 CIED 感染的发生率，并通过多变量分析评估了时期 II 中 CIED 感染的危险因素。
时期 I 和 II 中分别有 0.7%（5/709 例）和 1.7%（17/1040 例）的患者发生 CIED 感染。值得注意的是，尽管早期感染（≤6 个月）的发生率相似（0.4% vs. 0.6%，p=0.58），但时期 II 中晚期（>6 个月）CIED 感染的发生率显著增加（1.3% vs. 0.1%，p<0.01）。多因素逻辑回归分析显示，翻修术（比值比[95%置信区间]：5.2[1.6-16.3]，p=0.005）和年龄（0.96[0.93-0.99]，p=0.007）是时期 II 中 CIED 感染的独立危险因素。
我们的研究结果表明，当前临床环境下 CIED 感染发生率的增加归因于晚期 CIED 感染的增加。此外，翻修术和年龄较轻被确定为当前临床环境下 CIED 感染的独立危险因素。我们的数据表明，当计划对年轻患者进行翻修或植入时，临床医生应考虑该操作的益处是否能克服感染的风险。
