Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW.
Prince of Wales Hospital, Sydney, NSW.
Med J Aust. 2024 Jun 3;220(10):510-516. doi: 10.5694/mja2.52302. Epub 2024 May 6.
To quantify the rate of cardiac implantable electronic device (CIED)-related infections and to identify risk factors for such infections.
Retrospective cohort study; analysis of linked hospital admissions and mortality data.
SETTING, PARTICIPANTS: All adults who underwent CIED procedures in New South Wales between 1 January 2016 and 30 June 2021 (public hospitals) or 30 June 2020 (private hospitals).
Proportions of patients hospitalised with CIED-related infections (identified by hospital record diagnosis codes); risk of CIED-related infection by patient, device, and procedural factors.
Of 37 675 CIED procedures (23 194 men, 63.5%), 500 were followed by CIED-related infections (median follow-up, 24.9 months; interquartile range, 11.2-40.8 months), including 397 people (1.1%) within twelve months of their procedures, and 186 of 10 540 people (2.5%) at high risk of such infections (replacement or upgrade procedures; new cardiac resynchronisation therapy with defibrillator, CRT-D). The overall infection rate was 0.50 (95% confidence interval [CI], 0.45-0.54) per 1000 person-months; it was highest during the first month after the procedure (5.60 [95% CI, 4.89-6.42] per 1000 person-months). The risk of CIED-related infection was greater for people under 65 years of age than for those aged 65-74 years (adjusted hazard ratio [aHR], 1.71; 95% CI, 1.32-2.23), for people with CRT-D devices than for those with permanent pacemakers (aHR, 1.46; 95% CI, 1.02-2.08), for people who had previously undergone CIED procedures (two or more v none: aHR, 1.51; 95% CI, 1.02-2.25) or had CIED-related infections (aHR, 11.4; 95% CI, 8.34-15.7), or had undergone concomitant cardiac surgery (aHR, 1.62; 95% CI, 1.10-2.39), and for people with atrial fibrillation (aHR, 1.33; 95% CI, 1.11-1.60), chronic kidney disease (aHR, 1.54; 95% CI, 1.27-1.87), chronic obstructive pulmonary disease (aHR, 1.37; 95% CI, 1.10-1.69), or cardiomyopathy (aHR 1.60; 95% CI, 1.25-2.05).
Knowledge of risk factors for CIED-related infections can help clinicians discuss them with their patients, identify people at particular risk, and inform decisions about device type, upgrades and replacements, and prophylactic interventions.
量化心脏植入式电子设备（CIED）相关感染的发生率，并确定此类感染的危险因素。
回顾性队列研究；对医院入院和死亡率数据进行分析。
地点、参与者：2016 年 1 月 1 日至 2021 年 6 月 30 日期间在新南威尔士州接受 CIED 手术的所有成年人（公立医院）或 2020 年 6 月 30 日（私立医院）。
因 CIED 相关感染住院的患者比例（通过医院记录诊断代码确定）；患者、设备和手术因素与 CIED 相关感染的风险。
在 37675 例 CIED 手术中（23194 例男性，63.5%），有 500 例发生了 CIED 相关感染（中位随访时间为 24.9 个月；四分位间距为 11.2-40.8 个月），其中 397 例（1.1%）在手术后 12 个月内发生，186 例（2.5%）在高危人群中发生此类感染（更换或升级手术；新的心脏再同步治疗除颤器，CRT-D）。总体感染率为每 1000 人-月 0.50（95%置信区间，0.45-0.54）；术后第一个月感染率最高（每 1000 人-月 5.60 [95%CI，4.89-6.42]）。与 65-74 岁的人相比，年龄小于 65 岁的人发生 CIED 相关感染的风险更高（调整后的危险比[aHR]，1.71；95%置信区间，1.32-2.23）；与永久性起搏器相比，CRT-D 设备的人发生 CIED 相关感染的风险更高（aHR，1.46；95%CI，1.02-2.08）；与先前接受过 CIED 手术的人（两次或更多次与无手术相比：aHR，1.51；95%CI，1.02-2.25）或有 CIED 相关感染（aHR，11.4；95%CI，8.34-15.7）或同时进行心脏手术（aHR，1.62；95%CI，1.10-2.39）的人；与心房颤动（aHR，1.33；95%CI，1.11-1.60）、慢性肾脏病（aHR，1.54；95%CI，1.27-1.87）、慢性阻塞性肺疾病（aHR，1.37；95%CI，1.10-1.69）或心肌病（aHR 1.60；95%CI，1.25-2.05）的人相比。
了解 CIED 相关感染的危险因素可以帮助临床医生与患者讨论这些感染，识别出特定风险人群，并为设备类型、升级和更换以及预防性干预提供信息。
