Device infection in patients undergoing pacemaker or defibrillator surgery: risk stratification using the PADIT score

John de Heide, Marisa van der Graaf, Marijn J. Holl, Mark G. Hoogendijk, Rohit E. Bhagwandien, Sip A. Wijchers, Dominic A.M.J. Theuns, Tamas Szili-Torok, Felix Zijlstra, Mattie J. Lenzen, Sing Chien Yap*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: 

The use of an antibacterial envelope is cost-effective for patients at high risk of developing cardiac implantable electronic device (CIED) infection. The identification of these high-risk patients may be facilitated using a clinical risk score. The aim of the current study is to evaluate the PADIT score for identifying high-risk patients in patients undergoing a CIED procedure in a tertiary academic center.

Methods: 

This was a retrospective single-center study of consecutive patients undergoing a CIED procedure between January 2016 and November 2021. Patients who received an antibacterial envelope were excluded from this study. The primary endpoint was hospitalization for a CIED infection in the first year after the procedure. 

Results:

A total of 2333 CIED procedures were performed in the study period (mean age 61.6 ± 16.3 years, male sex 64.5%, previous CIED infection 1.7%, immunocompromised 5.4%). The median PADIT score was 4 (interquartile range, 2–6). CIED infection occurred in 10 patients (0.43%). The PADIT score had good discrimination in predicting major CIED infection (C-statistic 0.70; 95% confidence interval [CI] 0.54 to 0.86, P = 0.03). Using an optimal PADIT score cut-off value of 7, the risk of CIED infection was higher in the patients with a PADIT score of ≥ 7 in comparison to those with a lower PADIT score (1.23% vs. 0.26%, P = 0.02; odds ratio 4.8, 95% CI 1.4 to 16.6, P = 0.01). 

Conclusions: 

The PADIT score is a clinically useful score for identifying patients at high risk of developing CIED infection. The use of an antibacterial envelope in these high-risk patients may be cost-effective. Graphical Abstract: [Figure not available: see fulltext.]

Original languageEnglish
JournalJournal of Interventional Cardiac Electrophysiology
DOIs
Publication statusPublished - 21 Jan 2024

Bibliographical note

Publisher Copyright:
© 2024, The Author(s).

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