目的:量化心脏可植入电子设备(CIED)相关感染的发生率,并确定此类感染的危险因素。
方法:回顾性队列研究;关联住院率和死亡率数据的分析。
方法:在2016年1月1日至2021年6月30日(公立医院)或2020年6月30日(私立医院)期间在新南威尔士州接受CIED手术的所有成年人。
方法:因CIED相关感染而住院的患者比例(由医院记录诊断代码确定);患者发生CIED相关感染的风险,装置,和程序因素。
结果:在37675CIED程序中(23194名男性,63.5%),500例患者接受了CIED相关感染的随访(中位随访,24.9个月;四分位数范围,11.2-40.8个月),包括手术后十二个月内的397人(1.1%),10540人中有186人(2.5%)处于此类感染的高风险(更换或升级程序;除颤器的新心脏再同步治疗,CRT-D)。总感染率为0.50(95%置信区间[CI],每1000人-月0.45-0.54);手术后的第一个月最高(每1000人-月5.60[95%CI,4.89-6.42])。65岁以下人群的CIED相关感染风险高于65-74岁人群(调整后的风险比[aHR],1.71;95%CI,1.32-2.23),对于使用CRT-D设备的人,而不是那些使用永久性起搏器的人(AHR,1.46;95%CI,1.02-2.08),对于以前接受过ED手术的人(两个或两个以上v无:AHR,1.51;95%CI,1.02-2.25)或有ED相关感染(AHR,11.4;95%CI,8.34-15.7),或同时接受过心脏手术(AHR,1.62;95%CI,1.10-2.39),对于心房颤动患者(AHR,1.33;95%CI,1.11-1.60),慢性肾病(AHR,1.54;95%CI,1.27-1.87),慢性阻塞性肺疾病(aHR,1.37;95%CI,1.10-1.69),或心肌病(aHR1.60;95%CI,1.25-2.05)。
结论:了解CIED相关感染的危险因素可以帮助临床医生与患者讨论这些危险因素,识别有特殊风险的人,并告知有关设备类型的决定,升级和更换,和预防性干预措施。
OBJECTIVE: To quantify the rate of cardiac implantable electronic device (CIED)-related infections and to identify risk factors for such infections.
METHODS: Retrospective cohort study; analysis of linked hospital admissions and mortality data.
METHODS: All adults who underwent CIED procedures in New South Wales between 1 January 2016 and 30 June 2021 (public hospitals) or 30 June 2020 (private hospitals).
METHODS: Proportions of patients hospitalised with CIED-related infections (identified by hospital record diagnosis codes); risk of CIED-related infection by patient, device, and procedural factors.
RESULTS: Of 37 675 CIED procedures (23 194 men, 63.5%), 500 were followed by CIED-related infections (median follow-up, 24.9 months; interquartile range, 11.2-40.8 months), including 397 people (1.1%) within twelve months of their procedures, and 186 of 10 540 people (2.5%) at high risk of such infections (replacement or upgrade procedures; new cardiac resynchronisation therapy with defibrillator, CRT-D). The overall infection rate was 0.50 (95% confidence interval [CI], 0.45-0.54) per 1000 person-months; it was highest during the first month after the procedure (5.60 [95% CI, 4.89-6.42] per 1000 person-months). The risk of CIED-related infection was greater for people under 65 years of age than for those aged 65-74 years (adjusted hazard ratio [aHR], 1.71; 95% CI, 1.32-2.23), for people with CRT-D devices than for those with permanent pacemakers (aHR, 1.46; 95% CI, 1.02-2.08), for people who had previously undergone CIED procedures (two or more v none: aHR, 1.51; 95% CI, 1.02-2.25) or had CIED-related infections (aHR, 11.4; 95% CI, 8.34-15.7), or had undergone concomitant cardiac surgery (aHR, 1.62; 95% CI, 1.10-2.39), and for people with atrial fibrillation (aHR, 1.33; 95% CI, 1.11-1.60), chronic kidney disease (aHR, 1.54; 95% CI, 1.27-1.87), chronic obstructive pulmonary disease (aHR, 1.37; 95% CI, 1.10-1.69), or cardiomyopathy (aHR 1.60; 95% CI, 1.25-2.05).
CONCLUSIONS: Knowledge of risk factors for CIED-related infections can help clinicians discuss them with their patients, identify people at particular risk, and inform decisions about device type, upgrades and replacements, and prophylactic interventions.