BackgroundSubclinical infection of cardiac implantable electronic devices (CIEDs) is a common condition and increases the risk of clinical infection. However, there are limited studies focused on risk stratifying and prognostic analysis of subclinical CIED infection.Methods and ResultsData from 418 consecutive patients undergoing CIED replacement or upgrade between January 2011 and December 2019 were used in the analysis. Among the patients included, 50 (12.0%) were detected as positive by bacterial culture of pocket tissues. The most frequently isolated bacteria were coagulase‐negative staphylococci (76.9%). Compared with the noninfection group, more patients in the subclinical infection group were taking immunosuppressive agents, received electrode replacement, or received CIED upgrade and temporary pacing. Patients in the subclinical infection group had a higher PADIT (Prevention of Arrhythmia Device Infection Trial) score. Univariable and multivariable logistic regression analysis found that use of immunosuppressive agents (odds ratio [OR], 6.95 [95% CI, 1.44–33.51]; P=0.02) and electrode replacement or CIED upgrade (OR, 6.73 [95% CI, 2.23–20.38]; P=0.001) were significantly associated with subclinical CIED infection. Meanwhile, compared with the low‐risk group, patients in the intermediate/high‐risk group had a higher risk of subclinical CIED infection (OR, 3.43 [95% CI, 1.58–7.41]; P=0.002). After a median follow‐up time of 36.5 months, the end points between the subclinical infection group and noninfection group were as follows: composite events (58.0% versus 41.8%, P=0.03), rehospitalization (54.0% versus 32.1%, P=0.002), cardiovascular rehospitalization (32.0% versus 13.9%, P=0.001), CIED infection (2.0% versus 0.5%, P=0.32), all‐cause mortality (28.0% versus 21.5%, P=0.30), and cardiovascular mortality (10.0% versus 7.6%, P=0.57).ConclusionsSubclinical CIED infection was a common phenomenon. The PADIT score had significant value for stratifying patients at high risk of subclinical CIED infection. Subclinical CIED infection was associated with increased risks of composite events, rehospitalization, and cardiovascular rehospitalization.

中文翻译：

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亚临床心脏植入性电子设备感染的风险分层和预后分析：来自传统细菌培养的见解

背景心脏植入式电子设备（CIEDs）的亚临床感染是一种常见疾病，会增加临床感染的风险。然而，专注于亚临床 CIED 感染的风险分层和预后分析的研究有限。方法和结果 2011 年 1 月至 2019 年 12 月期间接受 CIED 更换或升级的 418 名连续患者的数据用于分析。在纳入的患者中，50例（12.0%）经袋组织细菌培养检测为阳性。最常分离的细菌是凝固酶阴性葡萄球菌（76.9%）。与非感染组相比，亚临床感染组更多的患者正在服用免疫抑制剂、接受电极更换或接受CIED升级和临时起搏。亚临床感染组患者的 PADIT（预防心律失常装置感染试验）评分较高。单变量和多变量逻辑回归分析发现，使用免疫抑制剂（优势比 [OR]，6.95 [95% CI，1.44–33.51]；P = 0.02）和电极更换或 CIED 升级（OR，6.73 [95% CI，2.23-20.38]；P = 0.001）与亚临床 CIED 感染显着相关。同时，与低风险组相比，中/高风险组患者发生亚临床CIED感染的风险更高（OR，3.43 [95% CI，1.58-7.41]；P = 0.002）。中位随访时间为 36.5 个月后，亚临床感染组和非感染组的终点如下：复合事件（58.0% 对 41.8%，P = 0.03）、再住院（54.0% 对 32.1%，P = 0.002），心血管再住院（32.0% 对 13.9%，P = 0.001），CIED 感染（2.0% 对 0.5%，P=0.32）、全因死亡率（28.0%对21.5%，P =0.30）和心血管死亡率（10.0%对7.6%，P =0.57）。结论亚临床CIED感染是一种常见现象。PADIT 评分对亚临床 CIED 感染高风险患者的分层具有重要价值。亚临床 CIED 感染与复合事件、再住院和心血管再住院的风险增加相关。