Risk Factors for CIED Infection After Secondary Procedures

OBJECTIVES This study aimed to identify risk factors for infection after secondary cardiac implantable electronic device (CIED) procedures. BACKGROUND Risk factors for CIED infection are not well defined and techniques to minimize infection lack supportive evidence. WRAP-IT (World-wide Randomized An...

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Autores: Tarakji, Khaldoun G., Krahn, Andrew D., Poole, Jeanne E., Mittal, Suneet, Kennergren, Charles, Biffi, Mauro, Korantzopoulos, Panagiotis, Dallaglio, Paolo D., Lexcen, Daniel R., Lande, Jeff D., Hilleren, Gregory, Holbrook, Reece, Wilkoff, Bruce L.
Formato: artículo
Estado:Versión publicada
Fecha de publicación:2021
País:España
Recursos:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
Repositorio:Recercat. Dipósit de la Recerca de Catalunya
OAI Identifier:oai:recercat.cat:2445/183415
Acesso em linha:https://hdl.handle.net/2445/183415
Access Level:acceso abierto
Palavra-chave:Desfibril·ladors cardioversors implantables
Infeccions
Implantable cardioverter-defibrillators
Infections
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spelling Risk Factors for CIED Infection After Secondary ProceduresTarakji, Khaldoun G.Krahn, Andrew D.Poole, Jeanne E.Mittal, SuneetKennergren, CharlesBiffi, MauroKorantzopoulos, PanagiotisDallaglio, Paolo D.Lexcen, Daniel R.Lande, Jeff D.Hilleren, GregoryHolbrook, ReeceWilkoff, Bruce L.Desfibril·ladors cardioversors implantablesInfeccionsImplantable cardioverter-defibrillatorsInfectionsOBJECTIVES This study aimed to identify risk factors for infection after secondary cardiac implantable electronic device (CIED) procedures. BACKGROUND Risk factors for CIED infection are not well defined and techniques to minimize infection lack supportive evidence. WRAP-IT (World-wide Randomized Antibiotic Envelope Infection Prevention trial), a large study that assessed the safety and efficacy of an antibacterial envelope for CIED infection reduction, offers insight into procedural details and infection prevention strategies. METHODS This analysis included 2,803 control patients from the WRAP-IT trial who received standard preoperative antibiotics but not the envelope (44 patients with major infections through all follow-up). A multivariate least absolute shrinkage and selection operator machine learning model, controlling for patient characteristics and procedural variables, was used for risk factor selection and identification. Risk factors consistently retaining predictive value in the model (appeared >10 times) across 100 iterations of imputed data were deemed significant. RESULTS Of the 81 variables screened, 17 were identified as risk factors with 6 being patient/device-related (nonmodifiable) and 11 begin procedure-related (potentially modifiable). Patient/device-related factors included higher number of previous CIED procedures, history of atrial arrhythmia, geography (outside North America and Europe), device type, and lower body mass index. Procedural factors associated with increased risk included longer procedure time, implant location (non-left pectoral subcutaneous), perioperative glycopeptide antibiotic versus nonglycopeptide, anticoagulant, and/or antiplatelet use, and capsulectomy. Factors associated with decreased risk of infection included chlorhexidine skin preparation and antibiotic pocket wash. CONCLUSIONS In WRAP-IT patients, we observed that several procedural risk factors correlated with infection risk. These results can help guide infection prevention strategies to minimize infections associated with secondary CIED procedures. (J Am Coll Cardiol EP 2022;8:101-111) (c) 2022 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).Elsevier BV2022202220212022info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersion11 p.application/pdfhttps://hdl.handle.net/2445/183415Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))reponame:Recercat. Dipósit de la Recerca de Catalunyainstname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)InglésReproducció del document publicat a: https://doi.org/10.1016/j.jacep.2021.08.009JACC: Clinical Electrophysiology, 2021, vol 8, num 1, p. 101-111https://doi.org/10.1016/j.jacep.2021.08.009cc by-nc-nd (c) Tarakji, Khaldoun G. et al, 2021http://creativecommons.org/licenses/by-nc-nd/3.0/es/info:eu-repo/semantics/openAccessoai:recercat.cat:2445/1834152026-05-29T05:05:01Z
dc.title.none.fl_str_mv Risk Factors for CIED Infection After Secondary Procedures
title Risk Factors for CIED Infection After Secondary Procedures
spellingShingle Risk Factors for CIED Infection After Secondary Procedures
Tarakji, Khaldoun G.
Desfibril·ladors cardioversors implantables
Infeccions
Implantable cardioverter-defibrillators
Infections
title_short Risk Factors for CIED Infection After Secondary Procedures
title_full Risk Factors for CIED Infection After Secondary Procedures
title_fullStr Risk Factors for CIED Infection After Secondary Procedures
title_full_unstemmed Risk Factors for CIED Infection After Secondary Procedures
title_sort Risk Factors for CIED Infection After Secondary Procedures
dc.creator.none.fl_str_mv Tarakji, Khaldoun G.
Krahn, Andrew D.
Poole, Jeanne E.
Mittal, Suneet
Kennergren, Charles
Biffi, Mauro
Korantzopoulos, Panagiotis
Dallaglio, Paolo D.
Lexcen, Daniel R.
Lande, Jeff D.
Hilleren, Gregory
Holbrook, Reece
Wilkoff, Bruce L.
author Tarakji, Khaldoun G.
author_facet Tarakji, Khaldoun G.
Krahn, Andrew D.
Poole, Jeanne E.
Mittal, Suneet
Kennergren, Charles
Biffi, Mauro
Korantzopoulos, Panagiotis
Dallaglio, Paolo D.
Lexcen, Daniel R.
Lande, Jeff D.
Hilleren, Gregory
Holbrook, Reece
Wilkoff, Bruce L.
author_role author
author2 Krahn, Andrew D.
Poole, Jeanne E.
Mittal, Suneet
Kennergren, Charles
Biffi, Mauro
Korantzopoulos, Panagiotis
Dallaglio, Paolo D.
Lexcen, Daniel R.
Lande, Jeff D.
Hilleren, Gregory
Holbrook, Reece
Wilkoff, Bruce L.
author2_role author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Desfibril·ladors cardioversors implantables
Infeccions
Implantable cardioverter-defibrillators
Infections
topic Desfibril·ladors cardioversors implantables
Infeccions
Implantable cardioverter-defibrillators
Infections
description OBJECTIVES This study aimed to identify risk factors for infection after secondary cardiac implantable electronic device (CIED) procedures. BACKGROUND Risk factors for CIED infection are not well defined and techniques to minimize infection lack supportive evidence. WRAP-IT (World-wide Randomized Antibiotic Envelope Infection Prevention trial), a large study that assessed the safety and efficacy of an antibacterial envelope for CIED infection reduction, offers insight into procedural details and infection prevention strategies. METHODS This analysis included 2,803 control patients from the WRAP-IT trial who received standard preoperative antibiotics but not the envelope (44 patients with major infections through all follow-up). A multivariate least absolute shrinkage and selection operator machine learning model, controlling for patient characteristics and procedural variables, was used for risk factor selection and identification. Risk factors consistently retaining predictive value in the model (appeared >10 times) across 100 iterations of imputed data were deemed significant. RESULTS Of the 81 variables screened, 17 were identified as risk factors with 6 being patient/device-related (nonmodifiable) and 11 begin procedure-related (potentially modifiable). Patient/device-related factors included higher number of previous CIED procedures, history of atrial arrhythmia, geography (outside North America and Europe), device type, and lower body mass index. Procedural factors associated with increased risk included longer procedure time, implant location (non-left pectoral subcutaneous), perioperative glycopeptide antibiotic versus nonglycopeptide, anticoagulant, and/or antiplatelet use, and capsulectomy. Factors associated with decreased risk of infection included chlorhexidine skin preparation and antibiotic pocket wash. CONCLUSIONS In WRAP-IT patients, we observed that several procedural risk factors correlated with infection risk. These results can help guide infection prevention strategies to minimize infections associated with secondary CIED procedures. (J Am Coll Cardiol EP 2022;8:101-111) (c) 2022 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
publishDate 2021
dc.date.none.fl_str_mv 2021
2022
2022
2022
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/183415
url https://hdl.handle.net/2445/183415
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: https://doi.org/10.1016/j.jacep.2021.08.009
JACC: Clinical Electrophysiology, 2021, vol 8, num 1, p. 101-111
https://doi.org/10.1016/j.jacep.2021.08.009
dc.rights.none.fl_str_mv cc by-nc-nd (c) Tarakji, Khaldoun G. et al, 2021
http://creativecommons.org/licenses/by-nc-nd/3.0/es/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv cc by-nc-nd (c) Tarakji, Khaldoun G. et al, 2021
http://creativecommons.org/licenses/by-nc-nd/3.0/es/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv 11 p.
application/pdf
dc.publisher.none.fl_str_mv Elsevier BV
publisher.none.fl_str_mv Elsevier BV
dc.source.none.fl_str_mv Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))
reponame:Recercat. Dipósit de la Recerca de Catalunya
instname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
instname_str Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
reponame_str Recercat. Dipósit de la Recerca de Catalunya
collection Recercat. Dipósit de la Recerca de Catalunya
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,812429

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