Hostname: page-component-586b7cd67f-r5fsc Total loading time: 0 Render date: 2024-12-01T03:32:19.414Z Has data issue: false hasContentIssue false
  • English
  • Français

Case-Control Study of Surgical Site Infections Associated With Pacemakers and Implantable Cardioverter-Defibrillators

Published online by Cambridge University Press:  02 January 2015

Jonas Marschall ,
Diane Hopkins-Broyles ,
Marilyn Jones ,
Victoria J. Fraser  and
David K. Warren
Jonas Marschall
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, Saint Louis, Missouri
Diane Hopkins-Broyles
Affiliation:
Infection Control, BJC Healthcare, Saint Louis, Missouri
Marilyn Jones
Affiliation:
Infection Control, BJC Healthcare, Saint Louis, Missouri
Victoria J. Fraser
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, Saint Louis, Missouri
David K. Warren*
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, Saint Louis, Missouri Infection Control, BJC Healthcare, Saint Louis, Missouri
*
Division of Infectious Diseases, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis MO 63110 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

In 2000, the rate of surgical site infections (SSIs) associated with pacemaker and implantable cardioverter-defibrillator (ICD) procedures performed in the cardiothoracic operating rooms of hospital A was 16% (19 of 116 procedures resulted in infections). This study investigates risks for SSI associated with these procedures in the cardiothoracic operating room.

Design.

Unmatched 1: 3 case-control study performed over a 12-month period among patients who had undergone implantation of a pacemaker and/or ICD. A standardized observation scrutinized infection control practices in the area where the procedures were performed.

Setting.

The cardiothoracic operating rooms of hospital A, which belongs to a hospital consortium in the midwestern United States.

Patients.

Patients with SSI were identified as case patients. Control patients were chosen from the group of uninfected patients who had procedures performed during the same period as case patients.

Results.

A total of 19 SSIs associated with pacemaker and ICD procedures were retrospectively identified among the patients who underwent procedures in these cardiothoracic operating rooms. Culture samples were obtained from 7 patients; 2 yielded coagulase-negative Staphylococcus on culture, 2 yielded Staphylococcus aureus, 1 yielded Serratia marcescens, and 2 showed no growth. In the case-control study, age, race, sex, diabetes mellitus, smoking history, timing of antibiotic therapy, and hair removal did not differ significantly between case patients and control patients. Case patients were more likely to have an abdominal device in place (odds ratio [OR], 5.5 [95% confidence interval {CI}, 1.6-19.3]; P = .006) and less likely to have received a new implant (OR 0.3 [95% CI, 0.1-0.8]; P = .02) or to have had new leads placed (OR, 0.2 [95% CI, 0.1-0.6]; P = .003).

Conclusions.

Abdominal placement of implanted devices was associated with occurrence of an SSI after pacemaker and/or ICD procedures.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 11 , November 2007 , pp. 1299 - 1304
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Slotwiner, DJ, Stein, KM, Markowitz, SM, et al. Emerging indications for cardiac pacing. Heart Dis 2001;3:224–230.Google Scholar
2.Goldberger, Z, Lampert, R. Implantable cardioverter-defibrillators: expanding indications and technologies. JAMA 2006;295:809–818.Google Scholar
3.Mond, HG, Irwin, M, Morillo, C, Ector, H. The world survey of cardiac pacing and cardioverter defibrillators: calendar year 2001. Pacing Clin Electrophysiol 2004;27:955–964.Google Scholar
4.Cabell, CH, Heidenreich, PA, Chu, VH, et al. Increasing rates of cardiac device infections among Medicare beneficiaries: 1990-1999. Am Heart J 2004;147:582–586.Google Scholar
5.Schmidt, B, Brunner, M, Olschewski, M, et al. Pacemaker therapy in very elderly patients: long-term survival and prognostic parameters. Am Heart J 2003;146:908–913.Google Scholar
6.Bloom, H, Heeke, B, Leon, A, et al. Renal insufficiency and the risk of infection from pacemaker or defibrillator surgery. Pacing Clin Electrophysiol 2006;29:142–145.Google Scholar
7.Al-Khatib, SM, Lucas, FL, Jollis, JG, Malenka, DJ, Wennberg, DE. The relation between patients' outcomes and the volume of cardioverter-defibrillator implantation procedures performed by physicians treating medicare beneficiaries. J Am Coll Cardiol 2005;46:1536–1540.Google Scholar
8.Borer, A, Gilad, J, Hyam, E, et al. Prevention of infections associated with permanent cardiac antiarrhythmic devices by implementation of a comprehensive infection control program. Infect Control Hosp Epidemiol 2004;25:492–497.Google Scholar
9.Mirowski, M. The automated implantable cardioverter-defibrillator: an overview. J Am Coll Cardiol 1985;6:461–466.Google Scholar
10.Samuels, LE, Samuels, FL, Kaufman, MS, Morris, RJ, Brockman, SK. Management of infected implantable cardiac defibrillators. Ann Thorac Surg 1997;64:1702–1706.Google Scholar
11.Ferguson, TB Jr, Ferguson, CL, Crites, K, Crimmins-Reda, P. The additional hospital costs generated in the management of complications of pacemaker and defibrillator implantations. J Thorac Cardiovasc Surg 1996;111:742–751.CrossRefGoogle ScholarPubMed
12.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.Google Scholar
13.Chua, JD, Wilkoff, BL, Lee, I, Juratli, N, Longworth, DL, Gordon, SM. Diagnosis and management of infections involving implantable electrophysiologic cardiac devices. Ann Intern Med 2000;133:604–608.CrossRefGoogle ScholarPubMed
14.Chamis, AL, Peterson, GE, Cabell, CH, et al. Staphylococcus aureus bacteremia in patients with permanent pacemakers or implantable cardioverter-defibrillators. Circulation 2001;104:1029–1033.Google Scholar
15.Garcia-Bolao, I, Alegria, E. Implantation of 500 consecutive cardiac pacemakers in the electrophysiology laboratory. Acta Cardiol 1999;54:339–343.Google ScholarPubMed
16.Harjula, A, Jarvinen, A, Virtanen, KS, Mattila, S. Pacemaker infections—treatment with total or partial pacemaker system removal. Thorac Cardiovasc Surg 1985;33:218–220.Google Scholar
17.Gold, MR, Peters, RW, Johnson, JW, Shorofsky, SR. Complications associated with pectoral cardioverter-defibrillator implantation: comparison of subcutaneous and submuscular approaches. J Am Coll Cardiol 1996;28:1278–1282.CrossRefGoogle ScholarPubMed
18.Spinier, SA, Nawarskas, JJ, Foote, EF, Sabapathi, D, Connors, JE, Marchlinski, FE. Clinical presentation and analysis of risk factors for infectious complications of implantable cardioverter-defibrillator implantations at a university medical center. Clin Infect Dis 1998;26:1111–1116.Google Scholar
19.Conklin, EF, Giannelli, S Jr, Nealon, TF Jr. Four hundred consecutive patients with permanent transvenous pacemakers. J Thorac Cardiovasc Surg 1975;69:1–7.CrossRefGoogle ScholarPubMed
20.Mela, T, McGovern, BA, Garan, H, et al. Long-term infection rates associated with the pectoral versus abdominal approach to cardioverter-defibrillator implants. Am J Cardiol 2001;88:750–753.Google Scholar
21.Paulson, DS. Efficacy evaluation of a 4% chlorhexidine gluconate as a full-body shower wash. Am J Infect Control 1993;21:205–209.CrossRefGoogle ScholarPubMed
22.Seal, LA, Paul-Cheadle, D. A systems approach to preoperative surgical patient skin preparation. Am J Infect Control 2004;32:57–62.Google Scholar
23.Mangram, AJ, Horan, TC, Pearson, ML, Silver, LC, Jarvis, WR. Guideline for prevention of surgical site infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control 1999;27:97–132.CrossRefGoogle ScholarPubMed
24.Webster, J, Osborne, S. Preoperative bathing or showering with skin antiseptics to prevent surgical site infection. Cochrane Database Syst Rev 2007;18:CD004985.Google Scholar
25.Classen, DC, Evans, RS, Pestotnik, SL, Horn, SD, Menlove, RL, Burke, JP. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med 1992;326:281–286.Google Scholar
26.Da Costa, A, Kirkorian, G, Cucherat, M, et al. Antibiotic prophylaxis for permanent pacemaker implantation: a meta-analysis. Circulation 1998;97:1796–1801.CrossRefGoogle ScholarPubMed
27.Institute for Healthcare Improvement: Campaign. Available at: http://www.ihi.org/IHI/Programs/Campaign/. Accessed August 13, 2007.Google Scholar
28.Giamarellou, H. Nosocomial cardiac infections. J Hosp Infect 2002;50:91–105.Google Scholar
29.Chua, JD, Abdul-Karim, A, Mawhorter, S, et al. The role of swab and tissue culture in the diagnosis of implantable cardiac device infection. PACE 2005;28:1276–1281.Google Scholar