David H Birnie1, Jia Wang2, Marco Alings3, François Philippon4, Ratika Parkash5, Jaimie Manlucu6, Paul Angaran7, Claus Rinne8, Benoit Coutu9, R Aaron Low10, Vidal Essebag11, Carlos Morillo12, Damian Redfearn13, Satish Toal14, Giuliano Becker15, Michel Degrâce16, Bernard Thibault17, Eugene Crystal18, Stanley Tung19, John LeMaitre20, Omar Sultan21, Matthew Bennett22, Jamil Bashir23, Felix Ayala-Paredes24, Philippe Gervais4, Leon Rioux25, Martin E W Hemels26, Leon H R Bouwels27, Derek V Exner12, Paul Dorian7, Stuart J Connolly2, Yves Longtin28, Andrew D Krahn29. 1. University of Ottawa Heart Institute, Ottawa, Ontario, Canada. 2. Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada. 3. Amphia Ziekenhuis and Working Group on Cardiovascular Research the Netherlands, Breda, the Netherlands. 4. Institut universitaire de cardiologie et de pneumologie de Québec, Laval University, Quebec City, Quebec, Canada. 5. Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada. 6. Lawson Health Research Institute, London Health Sciences, Western University, London, Ontario, Canada. 7. Department of Medicine, University of Toronto, Division of Cardiology, St. Michael Hospital, Toronto, Ontario, Canada. 8. St. Mary's General Hospital, Kitchener, Ontario, Canada. 9. Centre hospitalier de l'Université de Montréal, University of Montreal, Montreal, Quebec, Canada. 10. Chinook Regional Hospital, Lethbridge, Alberta, Canada. 11. McGill University Health Center, Montreal, Quebec, Canada. 12. Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada. 13. Kingston General Hospital, Queen's University, Kingston, Ontario, Canada. 14. Horizon Health Network, Saint John, New Brunswick, Canada. 15. Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, Quebec, Canada. 16. Hôtel-Dieu de Lévis, Lévis, Quebec, Canada. 17. Montreal Heart Institute, Montreal, Quebec, Canada. 18. Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. 19. St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada. 20. Royal Columbian Hospital, New Westminster, British Columbia, Canada. 21. Regina General Hospital, Saskatchewan Health Authority, Regina, Saskatchewan, Canada. 22. Regina General Hospital, Saskatchewan Health Authority, Regina, Saskatchewan, Canada; Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada. 23. University of British Columbia, Vancouver, British Columbia, Canada. 24. Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada. 25. Centre de santé et de services sociaux de Rimouski-Neigette, Rimouski, Quebec, Canada. 26. Rijnstate Hospital, Arnhem, the Netherlands; Radboud University Medical Centre, Nijmegen, the Netherlands. 27. Canisius Wilhelmina Ziekenhuis, Nijmegen, the Netherlands. 28. Jewish General Hospital Sir Mortimer B. Davis, McGill University, Montreal, Quebec, Canada. 29. University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: akrahn@mail.ubc.ca.
Abstract
BACKGROUND: Cardiac implantable electronic device infection is a major complication that usually requires device removal. PADIT (Prevention of Arrhythmia Device Infection Trial) was a large cluster crossover trial of conventional versus incremental antibiotics. OBJECTIVES: This study sought to investigate independent predictors of device infection in PADIT and develop a novel infection risk score. METHODS: In brief, over 4 6-month periods, 28 centers used either conventional or incremental prophylactic antibiotic treatment in all patients. The primary outcome was hospitalization for device infection within 1 year (blinded endpoint adjudication). Multivariable logistic prediction modeling was used to identify the independent predictors and develop a risk score for device infection. The prediction models were internally validated with bootstrap methods. RESULTS: Device procedures were performed in 19,603 patients, and hospitalization for infection occurred in 177 (0.90%) within 1 year of follow-up. The final prediction model identified 5 independent predictors of device infection (prior procedures [P], age [A], depressed renal function [D], immunocompromised [I], and procedure type [T]) with an optimism-corrected C-statistic of 0.704 (95% confidence interval: 0.660 to 0.744). A PADIT risk score ranging from 0 to 15 points classified patients into low (0 to 4), intermediate (5 to 6) and high (≥7) risk groups with rates of hospitalization for infection of 0.51%, 1.42%, and 3.41%, respectively. CONCLUSIONS: This study identified 5 independent predictors of device infection and developed a novel infection risk score in the largest cardiac implantable electronic device trial to date, warranting validation in an independent cohort. The 5 independent predictors in the PADIT score are readily adopted into clinical practice. (Prevention of Arrhythmia Device Infection Trial [PADIT Pilot]; NCT01002911).
BACKGROUND: Cardiac implantable electronic device infection is a major complication that usually requires device removal. PADIT (Prevention of Arrhythmia Device Infection Trial) was a large cluster crossover trial of conventional versus incremental antibiotics. OBJECTIVES: This study sought to investigate independent predictors of device infection in PADIT and develop a novel infection risk score. METHODS: In brief, over 4 6-month periods, 28 centers used either conventional or incremental prophylactic antibiotic treatment in all patients. The primary outcome was hospitalization for device infection within 1 year (blinded endpoint adjudication). Multivariable logistic prediction modeling was used to identify the independent predictors and develop a risk score for device infection. The prediction models were internally validated with bootstrap methods. RESULTS: Device procedures were performed in 19,603 patients, and hospitalization for infection occurred in 177 (0.90%) within 1 year of follow-up. The final prediction model identified 5 independent predictors of device infection (prior procedures [P], age [A], depressed renal function [D], immunocompromised [I], and procedure type [T]) with an optimism-corrected C-statistic of 0.704 (95% confidence interval: 0.660 to 0.744). A PADIT risk score ranging from 0 to 15 points classified patients into low (0 to 4), intermediate (5 to 6) and high (≥7) risk groups with rates of hospitalization for infection of 0.51%, 1.42%, and 3.41%, respectively. CONCLUSIONS: This study identified 5 independent predictors of device infection and developed a novel infection risk score in the largest cardiac implantable electronic device trial to date, warranting validation in an independent cohort. The 5 independent predictors in the PADIT score are readily adopted into clinical practice. (Prevention of Arrhythmia Device Infection Trial [PADIT Pilot]; NCT01002911).
Authors: François Philippon; Gilles E O'Hara; Jean Champagne; Stefan H Hohnloser; Michael Glikson; Jörg Neuzner; Philippe Mabo; Xavier Vinolas; Josef Kautzner; Fredrik Gadler; Noa Lashevsky; Stuart J Connolly; Yan Y Liu; Jeff S Healey Journal: CJC Open Date: 2020-04-25
Authors: Yves Longtin; Philippe Gervais; David H Birnie; Jia Wang; Marco Alings; François Philippon; Ratika Parkash; Jaimie Manlucu; Paul Angaran; Claus Rinne; Benoit Coutu; R Aaron Low; Vidal Essebag; Carlos Morillo; Damian Redfearn; Satish Toal; Giuliano Becker; Michel Degrâce; Bernard Thibault; Eugene Crystal; Stanley Tung; John LeMaitre; Omar Sultan; Matthew Bennett; Jamil Bashir; Felix Ayala-Paredes; Leon Rioux; Martin E W Hemels; Leon H R Bouwels; Derek V Exner; Paul Dorian; Stuart J Connolly; Andrew D Krahn Journal: Open Forum Infect Dis Date: 2021-10-14 Impact factor: 3.835
Authors: Bruce L Wilkoff; Giuseppe Boriani; Suneet Mittal; Jeanne E Poole; Charles Kennergren; G Ralph Corey; Andrew D Krahn; Edward J Schloss; Jose L Gallastegui; Robert A Pickett; Rudolph F Evonich; Steven F Roark; Denise M Sorrentino; Darius P Sholevar; Edmond M Cronin; Brett J Berman; David W Riggio; Hafiza H Khan; Marc T Silver; Jack Collier; Zayd Eldadah; Reece Holbrook; Jeff D Lande; Daniel R Lexcen; Swathi Seshadri; Khaldoun G Tarakji Journal: Circ Arrhythm Electrophysiol Date: 2020-09-11
Authors: Hillary J Mull; Kelly L Stolzmann; Marlena H Shin; Emily Kalver; Marin L Schweizer; Westyn Branch-Elliman Journal: JAMA Netw Open Date: 2020-09-01
Authors: Giuseppe Boriani; Marco Proietti; Matteo Bertini; Igor Diemberger; Pietro Palmisano; Stefano Baccarini; Francesco Biscione; Nicola Bottoni; Antonio Ciccaglioni; Alessandro Dal Monte; Franco Alberto Ferrari; Saverio Iacopino; Marcello Piacenti; Daniele Porcelli; Stefano Sangiorgio; Luca Santini; Michele Malagù; Giuseppe Stabile; Jacopo Francesco Imberti; Davide Caruso; Massimo Zoni-Berisso; Roberto De Ponti; Renato Pietro Ricci Journal: J Pers Med Date: 2022-01-11