Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan.
Division of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan.
J Hosp Infect. 2020 Jun;105(2):272-279. doi: 10.1016/j.jhin.2020.02.003. Epub 2020 Feb 11.
Clinical outcomes of patients undergoing a cardiac implantable electronic device (CIED) implantation following a recent non-device related infection are unknown.
To evaluate the clinical outcomes of patients with recent infection before CIED implantation.
Consecutive patients (N = 1237) were classified as patients with recent infection (N = 72) and without recent infection (N = 1165). A recent infection was established by reviewing medical records, including symptoms and clinical manifestations, diagnosis of systemic inflammatory response syndrome, and quick Sequential Organ Failure Assessment (qSOFA) score. Multiple stepwise logistic regression analysis was used to identify independent predictors of in-hospital all-cause mortality.
During nearly three years of follow-up, 17 patients had CIED infection (1.4%), and the incidence of CIED infection did not significantly differ between patients with and without recent infection according to symptoms and clinical manifestations (2.8% vs 1.3%, respectively; not significant). However, patients with recent infection had a significantly higher in-hospital mortality rate compared to those without recent infection (22.2% vs 0.9%, respectively; P < 0.05). In multivariate analysis, predictors of in-hospital mortality were recent infection before CIED implantation (odds ratio: 20.3; 95% confidence interval: 8.4-49.3; P < 0.001) and end-stage renal disease (4.3; 1.4-12.8; P = 0.009).
A CIED implantation is feasible in patients with recent infection if the patient is afebrile and has received an adequate duration of antibiotic therapy. Participants in shared decision-making before implant should be advised that recent infection increases in-hospital mortality risk, especially in patients with a qSOFA score of ≥2.
近期非器械相关感染后行心脏植入式电子设备（CIED）植入术患者的临床结局尚不清楚。
评估近期感染患者行 CIED 植入术的临床结局。
连续入选患者（N=1237）分为近期感染组（N=72）和无近期感染组（N=1165）。近期感染通过查阅病历，包括症状和临床表现、全身炎症反应综合征的诊断和快速序贯器官衰竭评估（qSOFA）评分来确定。采用多步逐步逻辑回归分析确定住院全因死亡率的独立预测因素。
在近 3 年的随访期间，17 例患者发生 CIED 感染（1.4%），有和无近期感染患者的 CIED 感染发生率无显著差异（分别为 2.8%和 1.3%，无显著差异）。然而，近期感染患者的住院死亡率显著高于无近期感染患者（分别为 22.2%和 0.9%，P<0.05）。多变量分析显示，住院死亡率的预测因素为 CIED 植入术前近期感染（比值比：20.3；95%置信区间：8.4-49.3；P<0.001）和终末期肾病（4.3；1.4-12.8；P=0.009）。
如果患者无发热且接受了足够疗程的抗生素治疗，近期感染患者可行 CIED 植入术。植入前参与共同决策的患者应被告知近期感染会增加住院死亡率风险，尤其是 qSOFA 评分≥2 的患者。
