Risk Factors for Infections Involving Cardiac Implanted Electronic Devices.

Autor:	Birnie DH; University of Ottawa Heart Institute, Ottawa, Ontario, Canada., Wang J; Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada., Alings M; Amphia Ziekenhuis and Working Group on Cardiovascular Research the Netherlands, Breda, the Netherlands., Philippon F; Institut universitaire de cardiologie et de pneumologie de Québec, Laval University, Quebec City, Quebec, Canada., Parkash R; Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada., Manlucu J; Lawson Health Research Institute, London Health Sciences, Western University, London, Ontario, Canada., Angaran P; Department of Medicine, University of Toronto, Division of Cardiology, St. Michael Hospital, Toronto, Ontario, Canada., Rinne C; St. Mary's General Hospital, Kitchener, Ontario, Canada., Coutu B; Centre hospitalier de l'Université de Montréal, University of Montreal, Montreal, Quebec, Canada., Low RA; Chinook Regional Hospital, Lethbridge, Alberta, Canada., Essebag V; McGill University Health Center, Montreal, Quebec, Canada., Morillo C; Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada., Redfearn D; Kingston General Hospital, Queen's University, Kingston, Ontario, Canada., Toal S; Horizon Health Network, Saint John, New Brunswick, Canada., Becker G; Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, Quebec, Canada., Degrâce M; Hôtel-Dieu de Lévis, Lévis, Quebec, Canada., Thibault B; Montreal Heart Institute, Montreal, Quebec, Canada., Crystal E; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada., Tung S; St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada., LeMaitre J; Royal Columbian Hospital, New Westminster, British Columbia, Canada., Sultan O; Regina General Hospital, Saskatchewan Health Authority, Regina, Saskatchewan, Canada., Bennett M; Regina General Hospital, Saskatchewan Health Authority, Regina, Saskatchewan, Canada; Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada., Bashir J; University of British Columbia, Vancouver, British Columbia, Canada., Ayala-Paredes F; Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada., Gervais P; Institut universitaire de cardiologie et de pneumologie de Québec, Laval University, Quebec City, Quebec, Canada., Rioux L; Centre de santé et de services sociaux de Rimouski-Neigette, Rimouski, Quebec, Canada., Hemels MEW; Rijnstate Hospital, Arnhem, the Netherlands; Radboud University Medical Centre, Nijmegen, the Netherlands., Bouwels LHR; Canisius Wilhelmina Ziekenhuis, Nijmegen, the Netherlands., Exner DV; Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada., Dorian P; Department of Medicine, University of Toronto, Division of Cardiology, St. Michael Hospital, Toronto, Ontario, Canada., Connolly SJ; Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada., Longtin Y; Jewish General Hospital Sir Mortimer B. Davis, McGill University, Montreal, Quebec, Canada., Krahn AD; University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: akrahn@mail.ubc.ca.
Jazyk:	angličtina
Zdroj:	Journal of the American College of Cardiology [J Am Coll Cardiol] 2019 Dec 10; Vol. 74 (23), pp. 2845-2854.
DOI:	10.1016/j.jacc.2019.09.060
Abstrakt:	Background: Cardiac implantable electronic device infection is a major complication that usually requires device removal. PADIT (Prevention of Arrhythmia Device Infection Trial) was a large cluster crossover trial of conventional versus incremental antibiotics. Objectives: This study sought to investigate independent predictors of device infection in PADIT and develop a novel infection risk score. Methods: In brief, over 4 6-month periods, 28 centers used either conventional or incremental prophylactic antibiotic treatment in all patients. The primary outcome was hospitalization for device infection within 1 year (blinded endpoint adjudication). Multivariable logistic prediction modeling was used to identify the independent predictors and develop a risk score for device infection. The prediction models were internally validated with bootstrap methods. Results: Device procedures were performed in 19,603 patients, and hospitalization for infection occurred in 177 (0.90%) within 1 year of follow-up. The final prediction model identified 5 independent predictors of device infection (prior procedures [P], age [A], depressed renal function [D], immunocompromised [I], and procedure type [T]) with an optimism-corrected C-statistic of 0.704 (95% confidence interval: 0.660 to 0.744). A PADIT risk score ranging from 0 to 15 points classified patients into low (0 to 4), intermediate (5 to 6) and high (≥7) risk groups with rates of hospitalization for infection of 0.51%, 1.42%, and 3.41%, respectively. Conclusions: This study identified 5 independent predictors of device infection and developed a novel infection risk score in the largest cardiac implantable electronic device trial to date, warranting validation in an independent cohort. The 5 independent predictors in the PADIT score are readily adopted into clinical practice. (Prevention of Arrhythmia Device Infection Trial [PADIT Pilot]; NCT01002911). (Copyright © 2019. Published by Elsevier Inc.)
Databáze:	MEDLINE
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