Presentation Outline ICHP Annual Meeting September 13-15

Methods‐ Data Collection
• Demographics
– Age
– Gender
– Comorbidities
– LVEF
• Procedure factors
– CIED type
– Leads
– Length of procedure
• Medication
– Anticoagulants
– Immunosuppressants
Patient Characteristics
• Outcomes
– Device Infection
– Cultures
• Culture positive
• Culture negative
– Time to infection
– Organism identified
• Gram positive
• Gram negative
– Susceptibilities
Characteristics CIED
(n=155)
Age (years), median (IQR) 63 (54‐74)
Male sex, no. (%) 95 (61.3)
Weight (kg), median (IQR)
Ethnicity, no. (%)
81.6 (68.9‐97.1)
African American
80 (51.6)
Caucasian 51 (32 (32.9) 9)
LVEF (%), median (IQR) 25 (15‐35)
SCr (mcg/dL), median (IQR) 1.1 (0.9‐1.4)
Co‐morbidities, no. (%)
Atrial fibrillation/flutter
COPD
CHF
CKD
Diabetes
HTN
Results‐ Infections
• Incidence of Infection= 2.6 %
Infection
(n=4)
Time to
infection
(days)
Organism Procedure
(prior to
infection)
1 28 Culture negative Upgrade CRT‐D‐
3 leads
2 48 Culture negative Generator ICD‐
replacement 2 leads
3 24 Staphylococcus aureus
(MSSA)
4 128 •Pseudomonas
aeruginosa
•Klebsiella pneumoniae
(pan‐susceptible)
54 (34.8)
32 (20.6)
108 (69.7)
47 (30.3)
49 (31.6)
128 (82.5)
Device Treatment
Levofloxacin &
clindamycin x14 d
replacement 2 leads
Vancomycin +
piperacillin/tazo
x14 d
Atrial lead
revision &
generator
replacement
PPM‐
2leads
Upgrade ICD‐
2 leads
Cefazolin x14 d
Vancomcyin +
Cefepime x14 d
Levofloxacin x7 d
Duration= 21 d
Patient Population
Cephalexin x72 hours
(n= 155 )
ICD 9 Codes
CIED implants (n=615 )
Inclusion
‐Age >18 and < 89 years
‐Recipient of new implanted CIED
*revised, upgrade, generator replaced
Exclusion
N= 460
Erx code: cephalexin
Patient Characteristics
•No preoperative abx or
received vancomycin
•Documented penicillin and/or
cephalosporin allergy
•Received antibiotics for
another indication
•Pregnancy
No post‐operative
cephalexin
(n= 0)
Characteristics CIED
(n=155)
Length of procedure (mins), median 78:52
Cefazolin preoperative dose (grams), median (IQR) 1 (1‐2)
Cumulative cefazolin (grams), median (IQR) 3 (3‐5)
•New CIED , no. (%)
112 (72.3)
PPM
37(23.9)
ICD
53(34.2)
CRT CRT‐DD 22( 14.2) 14 2)
•Lead Revision
4 (2.6)
•Upgrade
16 (10.3)
•Generator replacement
15(9.7)
•Lead revision and Generator replacement
8 ( 5.2)
•Temporary pacing wire, no. (%)
•Leads placed, no. (%)
11 (7.1)
2
42 (27.7)
PPM= Permanent pacemaker ICD= implantable cardiac defibrillator
CRT‐D= Cardiac resynchronization therapy with defibrillator
Results‐ Characteristics of Patients with
CIED Infection
Infection
(n=4)
Age,
yr
Sex DM CKD COPD History of
Valve
repair
1 62 M _ _ _
Oral
anticoagulant
+ +
Immunosuppressant
2 29 M _ _ _ _ _ _
3 85 M
+ +
4 53 F _ _
_ , Absent; +, Present
M= male; F= female
_ _
+
+ + +
_
_
_
8/29/2012
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