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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