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Timing of device reimplantation and reinfection rates following cardiac implantable electronic device infection: a systematic review and meta-analysis.

ABSTRACT: OBJECTIVES:Initial management of cardiac implantable electronic device (CIED) infection requires removal of the infected CIED system and treatment with systemic antibiotics. However, the optimal timing to device reimplantation is unknown. The aim of this study was to quantify the incidence of reinfection after initial management of CIED infection, and to assess the effect of timing to reimplantation on reinfection rates. DESIGN:Systematic review and meta-analysis. INTERVENTIONS:A systematic review and meta-analysis was performed of studies published up to February 2018. Inclusion criteria were: (a) documented CIED infection, (b) studies that reported the timing to device reimplantation and (c) studies that reported the proportion of participants with device reinfection. A meta-analysis of proportions using a random effects model was performed to estimate the pooled device reinfection rate. PRIMARY AND SECONDARY OUTCOME MEASURES:The primary outcome measure was the rate of CIED reinfection. The secondary outcome was all-cause mortality. RESULTS:Of the 280 screened studies, 8 met inclusion criteria with an average of 96 participants per study (range 15-220 participants). The pooled incidence rate of device reinfection was 0.45% (95% CI, 0.02% to 1.23%) per person year. A longer time to device reimplantation >72 hours was associated with a trend towards higher rates of reinfection (unadjusted incident rate ratio 4.8; 95% CI 0.9 to 24.3, p=0.06); however, the meta-regression analysis was unable to adjust for important clinical covariates. There did not appear to be a difference in reinfection rates when time to reimplantation was stratified at 1 week. Heterogeneity was moderate (I2=61%). CONCLUSIONS:The incident rate of reinfection following initial management of CIED infection is not insignificant. Time to reimplantation may affect subsequent rates of device reinfection. Our findings are considered exploratory and significant heterogeneity limits interpretation. PROSERO REGISTRATION NUMBER:CRD4201810960.

SUBMITTER: Chew D

PROVIDER: S-EPMC6731831 | biostudies-other | 2019 Sep

REPOSITORIES: biostudies-other

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Timing of device reimplantation and reinfection rates following cardiac implantable electronic device infection: a systematic review and meta-analysis.

Chew Derek D Somayaji Ranjani R Conly John J Exner Derek D Rennert-May Elissa E

BMJ open 20190903 9

<h4>Objectives</h4>Initial management of cardiac implantable electronic device (CIED) infection requires removal of the infected CIED system and treatment with systemic antibiotics. However, the optimal timing to device reimplantation is unknown. The aim of this study was to quantify the incidence of reinfection after initial management of CIED infection, and to assess the effect of timing to reimplantation on reinfection rates.<h4>Design</h4>Systematic review and meta-analysis.<h4>Interventions ...[more]

PMID: 31481556

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Project description:ImportanceCardiac implantable electronic device (CIED) infection is a potentially devastating complication with an estimated 12-month mortality of 15% to 30%. The association of the extent (localized or systemic) and timing of infection with all-cause mortality has not been established.ObjectiveTo evaluate the association of the extent and timing of CIED infection with all-cause mortality.Design, setting, and participantsThis prospective observational cohort study was conducted between December 1, 2012, and September 30, 2016, in 28 centers across Canada and the Netherlands. The study included 19 559 patients undergoing CIED procedures, 177 of whom developed an infection. Data were analyzed from April 5, 2021, to January 14, 2023.ExposuresProspectively identified CIED infections.Main outcomes and measuresTime-dependent analysis of the timing (early [≤3 months] or delayed [3-12 months]) and extent (localized or systemic) of infection was performed to determine the risk of all-cause mortality associated with CIED infections.ResultsOf 19 559 patients undergoing CIED procedures, 177 developed a CIED infection. The mean (SD) age was 68.7 (12.7) years, and 132 patients were male (74.6%). The cumulative incidence of infection was 0.6%, 0.7%, and 0.9% within 3, 6, and 12 months, respectively. Infection rates were highest in the first 3 months (0.21% per month), reducing significantly thereafter. Compared with patients who did not develop CIED infection, those with early localized infections were not at higher risk for all-cause mortality (no deaths at 30 days [0 of 74 patients]: adjusted hazard ratio [aHR], 0.64 [95% CI, 0.20-1.98]; P = .43). However, patients with early systemic and delayed localized infections had an approximately 3-fold increase in mortality (8.9% 30-day mortality [4 of 45 patients]: aHR, 2.88 [95% CI, 1.48-5.61]; P = .002; 8.8% 30-day mortality [3 of 34 patients]: aHR, 3.57 [95% CI, 1.33-9.57]; P = .01), increasing to a 9.3-fold risk of death for those with delayed systemic infections (21.7% 30-day mortality [5 of 23 patients]: aHR, 9.30 [95% CI, 3.82-22.65]; P < .001).Conclusions and relevanceFindings suggest that CIED infections are most common within 3 months after the procedure. Early systemic infections and delayed localized infections are associated with increased mortality, with the highest risk for patients with delayed systemic infections. Early detection and treatment of CIED infections may be important in reducing mortality associated with this complication.

Dataset Information

Timing of device reimplantation and reinfection rates following cardiac implantable electronic device infection: a systematic review and meta-analysis.

Publications

Timing of device reimplantation and reinfection rates following cardiac implantable electronic device infection: a systematic review and meta-analysis.

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