1106. Factors Associated with Increased Mortality in Patients Undergoing Extraction of Cardiovascular Implantable Electronic Devices Due to Infection
Session: Poster Abstract Session: Infections of Cardiovascular Devices
Saturday, October 22, 2011
Room: Poster Hall B1
 

Background: With an ever-growing number of cardiovascular implantable electronic devices (CIED) needed especially in the elderly population the burden of device-related infections is increasing. Antimicrobial therapy alone has an unacceptably high treatment failure rate. Thus device removal including lead extraction must be sought.  However, co-morbid conditions are frequent in this population and required extraction/hospitalization carries potential additional risks.

Methods: We reviewed the medical records of 400 patients who underwent device extraction for CIED-related infection at a tertiary referral center between 1991 and 2007.  Patient characteristics and clinical data were extracted and analyzed.  

Results: The average patient age was 69 years. One-month and one-year mortality were 8 and 24%, respectively. Increased one-year mortality was associated with advanced age. Patients more likely to die within one year presented with fever (OR 2.0; 95% CI 1.2-3.1), hypotension (OR 3.7; 1.7-8.0), evidence of a vegetation on echocardiography (OR 2.7; 1.7-4.6), bacteremia (OR 2.8; 1.7-4.6), and Staphylococcus aureus infections (OR 2.3; 1.4-0.9).  Other risk factors were referral from an outside institution (OR 1.9; 1.1-3.3), presence of chronic central venous catheters (OR 3.3; 1.5-7.4), need for chronic hemodialysis (OR 3.8; 1.9-7.6), and presence of a secondary focus of infection (OR 2.8; 1.6-4.8). In contrast, local signs of swelling (OR 0.5; 0.3-0.9), erosion (OR 0.3; 0.1-0.5) and drainage (OR 0.5; 0.3-0.8) were associated with a survival benefit.  After multivariate analysis, advanced age, need for chronic hemodialysis, and erosion remained statistically significant.

Conclusion: CIED are a well-established treatment modality for a variety of cardiac conditions. When infections occur complete device removal is necessary.  In our experience, infection and needed extraction/hospitalization were not infrequently associated with complications and carried significant mortality particularly in patients with chronic indwelling venous catheters on hemodialysis. More emphasis must be placed on early detection of CIED-related infections and better prevention strategies should be sought for high-risk populations.


Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

Sarah Aleem, MD1, Dong Heun Lee, MD1, George A. Yesenosky, MD2, Steven P. Kutalek, MD2 and Ole Vielemeyer, MD1, (1)Division of Infectious Diseases and HIV Medicine, Drexel University College of Medicine, Philadelphia, PA, (2)Division of Cardiovascular Diseases, Drexel University College of Medicine, Philadelphia, PA

Disclosures:

S. Aleem, None

D. H. Lee, None

G. A. Yesenosky, None

S. P. Kutalek, None

O. Vielemeyer, None

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