Incidence and risk factors of cardiac implantable electronic device infection in present clinical settings in a Turkish population: A 10-year single-center observational research
B Ates, E Baskovski, S Atan, A T Altin, O AkyurekAbstract
Background
Implantable cardiac devices are widely used for rhythm disorders, yet infection remains one of the most serious complications, increasing morbidity, mortality, and healthcare burden. Identifying modifiable risk factors is essential to prevent infection and avoid extraction.
Purpose
To determine infection incidence and evaluate clinical and procedural risk factors associated with implantable cardiac electronic device infections.
Methods
A retrospective cohort of consecutive patients receiving permanent pacemakers, defibrillators, or generator/lead replacement procedures (2014–2023) was evaluated. Demographic data, comorbidities, medications, laboratory findings, procedural characteristics (device type, number of leads, duration, need for temporary pacing, re-intervention, hematoma), and microbiological results were analyzed. Infection was defined as local pocket infection or systemic involvement confirmed clinically and microbiologically. Univariate and multivariate logistic regression and Cox analysis were performed.
Results
Among 2,202 procedures, 113 patients (4.8%) developed device-associated infection. Infections occurred more frequently in males (66.7%). In univariate analysis, risk increased with cardiac resynchronization therapy implantation (OR 2.8), ≥3 leads (OR 2.9), early re-intervention (OR 3.6), and pocket hematoma (OR 5.4). Procedure duration was significantly longer in the infection group (p<0.001). In multivariate analysis, hematoma and longer procedure time remained independent predictors of infection (p<0.01). Cox regression among redo procedures identified the number of leads, early reintervention, hematoma, and low ejection fraction as predictors of earlier infection.
Conclusion
Hematoma formation and prolonged procedure duration significantly increase device-associated infection risk. Using the simplest device compatible with patient needs, minimizing re-interventions, avoiding unnecessary leads, meticulous bleeding control, and shortening procedural duration may reduce infection rates.Patient Flow an Distribution of CIEDUnivariate and multivariate analys