1107. Impact of a Primary Inpatient Electrophysiology Service on Cardiovascular Implantable Electronic Device Infections in a Tertiary Care Hospital
Session: Poster Abstract Session: Clinical Infectious Diseases: Bacteremia and Endocarditis
Friday, October 28, 2016
Room: Poster Hall
Background: Rates of cardiovascular implantable electronic device (CIED) implantation and CIED infections (CIEDI) have risen in the past decade. In 2003, the American Heart Association (AHA) recommended CIEDI management strategies to improve patient outcomes, such as hospital length of stay (LOS). However, in a prior review of management trends at our institution from 1991-2010, these improvements were not observed. A primary inpatient heart rhythm (HR) service was formed in our hospital in 2014. CIEDI patients were preferentially admitted to this service to improve the quality of care.

Methods: This is a retrospective review of patients identified from an existing institutional CIEDI database. We compared patients in 3 groups: 1) admissions before existence of HR in 2014 (“pre-HR”), 2) admissions after 2014 to HR (“HR”), and 3) admissions after 2014 but to other services (“post-non-HR”). Variables included hospital and intensive care unit (ICU) LOS; mortality; duration of antibiotics and temporary pacemaker use; and times to consultation of subspecialties, CIED extraction, pocket closure, and new CIED implantation. Chi-square analysis was used to compare categorical variables, Kruskal-Wallis test for continuous variables, and multivariate analysis for adjustment of infection type.

Results: There were a total of 210 CIEDI cases: pre-HR n=102, HR n=48, and post-non-HR n=60. Groups were similar in age, gender, ethnicity, and CIED type. However, there was a significantly higher percent of pulse generator pocket infections (83.3%) admitted to HR as compared to post-non-HR (21.7% pocket, 78.3% systemic, p<0.0001). After adjusting for infection types, HR patients were more likely to have had a surgical consult (OR 7.01, 95% CI 1.56-31.5, p=0.011) and shortened time to pocket closure (-2.21 days, 95% CI -3.33 to -1.09, p<0.001) compared to pre-HR.

Conclusion: CIEDI admissions to HR were predominately generator pocket infections, likely because patients with overt signs of CIEDI were triaged to this service. After adjusting for infection type, the HR service was associated with a significant increase in surgical consultation and decreased time to pocket closure. However, other factors, such as hospitalization costs, LOS, and mortality, were not affected.

Eugene M. Tan, MD1, Avish Nagpal, MD2, Daniel C. Desimone, MD3, Brenda Anderson, RN4, Jane Linderbaum, APRN, CNP4, Thomas De Ziel, RN4, Zhuo Li, MS5, Muhammad R. Sohail, MD, FIDSA6, Yong-Mei Cha, M.D.4, Erica Loomis, MD4, Raul Espinosa, MD4, Paul a. Friedman, MD7, Kevin Greason, MD4, Henry Schiller, MD4, Abinash Virk, MD, FIDSA8, Walter R. Wilson, MD, FIDSA9, James M. Steckelberg, MD, FIDSA2 and Larry M. Baddour, MD, FIDSA2, (1)Internal Medicine, Mayo Clinic, Rochester, MN, (2)Infectious Diseases, Mayo Clinic, Rochester, MN, (3)Infectious Diseases, Mayo Clinic College of Medicine, Rochester, MN, (4)Mayo Clinic, Rochester, MN, (5)Mayo Clinic, Jacksonville, FL, (6)200 First Street SW, Mayo School of Graduate Medical Education, Rochester, MN, (7)Cardiovascular Diseases, Mayo Clinic, Rochester, MN, (8)Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Rochester, MN, (9)Infectious Diseases, Mayo School of Graduate Medical Education, Rochester, MN

Disclosures:

E. M. Tan, None

A. Nagpal, None

D. C. Desimone, None

B. Anderson, None

J. Linderbaum, None

T. De Ziel, None

Z. Li, None

M. R. Sohail, Medtronic: Consultant , Consulting fee and Research grant
Spectranetics: Consultant , Consulting fee
Boston Scientific: Consultant , Consulting fee

Y. M. Cha, None

E. Loomis, None

R. Espinosa, None

P. A. Friedman, None

K. Greason, None

H. Schiller, None

A. Virk, None

W. R. Wilson, None

J. M. Steckelberg, None

L. M. Baddour, UpToDate: Consultant , Licensing agreement or royalty
Massachusetts Medical Society: NEJM Journal Watch Infectious Diseases – Editor-in-Chief , Editor-in-Chief duties

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