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Risk factors and time delay associated with cardiac device infections. Leiden Device Registry
  1. Jaco C Lekkerkerker (jclekkerkerker{at}casema.nl)
  1. Leiden University Medical Centre, Netherlands
    1. Cees van Nieuwkoop
    1. Leiden University Medical Centre, Netherlands
      1. Serge A. Trines
      1. Leiden University Medical Centre, Netherlands
        1. Johanna G. van der Bom
        1. Leiden University Medical Centre, Netherlands
          1. Alexandre Bernards
          1. Leiden University Medical Centre, Netherlands
            1. Enno T van der Velde
            1. Leiden University Medical Centre, Netherlands
              1. Marianne Bootsma
              1. Leiden University Medical Centre, Netherlands
                1. Katja Zeppenveld
                1. Leiden University Medical Centre, Netherlands
                  1. Wouter Jukema
                  1. Leiden University Medical Centre, Netherlands
                    1. Jan-Willem Borleffs
                    1. Leiden University Medical Centre, Netherlands
                      1. Martin J. Schalij
                      1. Leiden University Medical Centre, Netherlands
                        1. Liselot van Erven
                        1. Leiden University Medical Centre, Netherlands

                          Abstract

                          Aims: A nested case-control study of 75 patients with CDI and 75 matched controls was conducted to evaluate time course, risk factors, culture results and frequency of CDI.

                          Methods and Results: CDI occurred in 75/3410 (2.2%) device implantation and revision procedures, performed between 2000 and 2007. The time delay between device procedure and infection ranged from 0 to 64 months (14±16), 21 patients (28%) had an early infection (<1 month), 26 (35%) a late infection (1-12 months) and 28 (37%) a delayed infection (>12 months). Of interest, 18 (24%) patients presented with an infection > 24 months following the device related procedure. Time delay until infection was significantly shorter when cultures were positive for micro-organisms compared to negative cultures (8±12 vs. 18±18 months, p = 0.03). Pocket cultures in delayed infections remained more often negative (61% vs. 23%, p = 0.01). Independent CDI risk factors were: Device revision (odds ratio (OR) 3.67; 95% confidence interval (CI), 1.51-8.96), renal dysfunction defined as GFR < 60 ml/min (OR 4.64; CI, 1.48-14.62) and oral anticoagulation use (OR 2.83; CI 1.20-6.68).

                          Conclusion: CDI occurred in 2.2% of device procedures, with 24% occurring more than 2 years after the device related procedure. Renal dysfunction, device revisions and oral anticoagulation are potent risk factors for CDI.

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