Infection after pacemaker implantation: infection rates and risk factors associated with infection in a population-based cohort study of 46299 consecutive patients

Abstract

Aims

Infection is a serious complication of pacemaker (PM) systems. Although the rate of infection has been debated, the figures are largely unknown. We therefore studied the incidence of PM infection and its associated risk factors in the Danish population.

Methods and results

Since 1982, all PM implantation and removal procedures performed in Denmark have been prospectively recorded in the Danish Pacemaker Register. All patients ( n = 46299) who underwent implantation between 1982 and 2007 were included. The total length of surveillance was 236 888 PM-years. The incidence of infection was calculated according to the total number of PM-years. The incidence of surgical site infection (≤365 days after PM implantation) was compared with later infection in first implant and replacement procedures. Multiple-record and multiple-event-per-subject proportional hazards analyses were used to identify the independent risk factors of PM infection. Surgical site infection occurred in 192 cases after first implantation (incidence rate 4.82/1000 PM-years), and in 133 cases after replacement (12.12/1000 PM-years). Infections occurring more than 365 days after the first implantation occurred in 153 cases (1.02/1000 PM-years), and in 118 cases after replacement (3.26/1000 PM-years). Independent factors associated with an increased risk of PM infection were a greater number of PM operations (including replacements), male sex, younger age, implantation during the earliest part of the study period, and absence of antibiotics ( P< 0.001).

Conclusion

The overall risk of infection after PM implantation was low. A greater number of operations augmented the risk of infection. This should be taken into account when considering revisions of PM systems.

Journal

Journal ID (nlm-ta): Eur Heart J

Journal ID (publisher-id): eurheartj

Journal ID (hwp): ehj

Title: European Heart Journal

Publisher: Oxford University Press

ISSN (Print): 0195-668X

ISSN (Electronic): 1522-9645

Publication date (Print): April 2011

Publication date (Electronic): 20 January 2011

Publication date PMC-release: 20 January 2011

Volume: 32

Issue: 8

Pages: 991-998

Affiliations

[1 ]simpleDanish Pacemaker Register , Department of Cardiology, Odense University Hospital, DK 5000 Odense C, Denmark

[2 ]Department of Cardiology, simpleAarhus University Hospital , Skejby, Brendstrupgaardsvej 100, DK 8200 Aarhus N, Denmark

[3 ]Department of Heart, Lung, and Vascular Surgery, simpleOdense University Hospital , DK 5000 Odense C, Denmark

[4 ]Department of Cardiology, simpleOdense University Hospital , DK 5000 Odense C, Denmark

Author notes

[* ]Corresponding author. Tel: [phone], Fax: [phone], Email: brock@ 123456dadlnet.dk

Article

Publisher ID: ehq497

DOI: 10.1093/eurheartj/ehq497

PMC ID: 3076667

PubMed ID: 21252172

SO-VID: fe2d36e1-f6fb-4ccd-a261-ccee1c09de0a

Copyright statement: Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2011. For permissions please email: [e-mail]

License:

The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that the original authorship is properly and fully attributed; the Journal, Learned Society and Oxford University Press are attributed as the original place of publication with correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact [e-mail].

Product

Categories

Subject: Clinical Research

Subject: Arrhythmia/Electrophysiology