Risk factor analysis of permanent pacemaker infection

Background. Several host- and procedure-related factors have been reported to increase the risk of permanent pacemaker ( PPM) infection on the basis of descriptive analyses of case series. The purpose of this study is to assess the risk factors for PPM infection using case-control study methods. Methods. All patients who had a PPM implanted at our institution from January 1991 to December 2003 were retrospectively reviewed. Each patient who experienced a PPM infection was matched with 2 control subjects by age, sex, year of implantation, and duration of follow-up. Univariate and multivariable analyses were performed to identify significant risk factors for PPM infection. Results. Twenty-nine case patients and 58 control subjects met inclusion criteria. The majority ( 83%) of case patients presented with a pocket infection; a minority ( 10%) had PPM-related endocarditis. Staphylococcus species ( 69%) were the most common pathogens. On univariate analysis, previous PPM infection, malignancy, long-term corticosteroid use, multiple device revisions, a permanent central venous catheter, the presence of > 2 pacing leads, and a lack of antibiotic prophylaxis at the time of PPM placement were associated with an increased risk of PPM infection. A multivariable logistic regression model identified long-term corticosteroid use ( odds ratio [ OR], 13.90; 95% confidence interval [ CI], 1.27 - 151.7; P = .03) and the presence of > 2 pacing leads versus 2 leads ( OR, 5.41; 95% CI, 1.44 - 20.29; P = .01) as independent risk factors for PPM infection. In contrast, use of antibiotic pro phylaxis prior to PPM implantation had a protective effect ( OR, 0.087; 95% CI, 0.016 - 0.48; P = .005). Conclusions. These findings should assist clinicians in identifying patients who are at increased risk of PPM infection, as well as in developing strategies to minimize the modifiable risks.