Introduction

1. Introduction • Cardiovascular implantable electronic device (CIED) infections have been primarily attributed to recent CIED placement or manipulation1 • There exists little prospective data regarding early versus late CIED pocket infections, including host and device-related risk factors, clinical presentation, and microbiology.2 Variability in Clinical Features of Early Versus Late Cardiovascular Implantable Electronic Device Pocket Infections Mariko P. Welch, M.D., Jordan M. Prutkin, M.D., MHS, Arnold J. Greenspon MD, M. Rizwan Sohail MD, Holenarasipur R. Vikram MD, Larry M. Baddour MD, Stephan B. Danik MD, James PeacockMD, Ana del Rio MD, Jose M. Miro MD, LiobaWaidelich MD, Christoph Naber MD, Roger G. Carrillo MD, Walter Hellinger, MD, Chi-Hong Tseng PhD, Katherine Y. Le, MD, and Daniel Z. Uslan MD for the MEDIC Investigators University of Washington, Seattle, WA; Thomas Jefferson University, Philadelphia, PA; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Massachusetts General Hospital, Boston, MA; Wake Forest University, Winston-Salem, NC; Hospital Clinic, IDIBAS, University of Barcelona, Barcelona, Spain; Elisabeth Krankenhaus, Essen, Germany; University of Miami, Miami, FL; Mayo Clinic, Jacksonville, FL; David Geffen School of Medicine at UCLA, Los Angeles, CA Subject Demographics Microbiology p=0.05 MEDIC Non-staphylococcus Staphylococcus Discussion • In this cohort, 43% of pocket infections presented >12 months since last CIED related procedure • Female sex and anticoagulation use were more frequent in the early infection group. • Inflammatory changes at the generator pocket were more frequent with early-onset infections and these patients were more likely to have undergone a generator change or lead addition as the last CIED-related procedure. • Late pocket infections more often presented with erosion, with valve vegetations, and were more likely to be due to non-Staphylococcal species. Methods • Multicenter Electrophysiologic Device Infection Cohort (MEDIC) • is a prospective registry of CIED infections from 11 international centers. • Pocket infection was defined by presence of local inflammatory changes or generator/lead erosion and/or positive cultures from the pocket obtained at the time of CIED explantation. • Cases that had positive blood cultures or intracardiac vegetations were included if pocket infection was also found • All cases of pocket infection were included regardless of whether the CIED was extracted or method of extraction. • Early infections were defined as occurring within 12 months of last CIED procedure; Late were those >12 months. • Categorical variables were compared by the χ2 test statistic and continuous variables by Student’s t-test. Clinical Presentation References 1. Baddour LM, Epstein AE, Erickson CC, et al. A summary of the update on cardiovascular implantable electronic device infections and their management: a scientific statement from the American Heart Association. Circulation. 2010 Jan 26;121(3):458-77. 2. Sohail MR, Hussain S, Le KY et al. Risk factors associated with early- verus late-onset implantable cardioverter-defibrillator infections. J Interv Card Electrophysiol 2011;31:171-183. Disclosures Roger Carrillo M.D.: Spectranetics (Consulting, significant). Medtronic, St. Jude Medical Corp, Sorin Group, Boston Scientific Corp (Speaker’s Bureau, all modest). St. Jude Medical Corp (Research grant, modest). M. Rizwan Sohail, M.D.: Funding from TYRX for prior research unrelated to this study, administered according to a sponsored research agreement (SRA) that prospectively defined the scope of the research effort and corresponding budget.   Daniel Z. Uslan, M.D:: Medtronic, BIOTRONIK (honoraria). TyRx, Inc (Consulting).