Table 2.
Procedural Characteristics for Device Procedures by Infection Status.
| Variable | Total (N = 2107) | No CIED infection* (N = 2010) | CIED Infection* (N = 97) | P-value |
|---|---|---|---|---|
| Training Set | 1,387 (65.8%) | 1,323 (65.8%) | 64 (66.0%) | 0.97 |
| Validation Set | 720 (34.2%) | 687 (34.2%) | 33 (34.0%) | |
| Type of device | ||||
| Biventricular Pacemaker | 36 (1.7%) | 34 (1.7%) | 2 (2.1%) | 0.68 |
| Biventricular Pacemaker-ICD | 282 (13.4%) | 267 (13.3%) | 15 (15.5%) | 0.54 |
| Permanent Pacemaker | 1,204 (57.1%) | 1,159 (57.7%) | 45 (46.4%) | 0.028 |
| ICD | 600 (28.5%) | 565 (28.1%) | 35 (36.1%) | 0.089 |
| Procedural variables | ||||
| Elective procedure | 1,589 (75.4%) | 1,526 (75.9%) | 63 (64.9%) | 0.014 |
| Index was revision procedure* | 787 (37.4%) | 734 (36.5%) | 53 (54.6%) | 0.0003 |
| Repeat CIED procedure | 91 (4.3%) | 85 (4.2%) | 6 (6.2%) | 0.35 |
| Diagnostic variables | ||||
| Microbiology order | 542 (25.7%) | 453 (22.5%) | 89 (91.8%) | <0.0001 |
| ID consult recorded* | 122 (5.8%) | 78 (3.9%) | 44 (45.4%) | <0.0001 |
| Fever | 23 (1.1%) | 19 (0.9%) | 4 (4.1%) | 0.019 |
| Culture positive* | 99 (4.7%) | 49 (2.4%) | 50 (51.5%) | <0.0001 |
| Wound culture order | 199 (9.4%) | 144 (7.2%) | 55 (56.7%) | <0.0001 |
| Wound culture positive* | 55 (2.6%) | 14 (0.7%) | 41 (42.3%) | <0.0001 |
| Blood culture order | 503 (23.9%) | 425 (21.1%) | 78 (80.4%) | <0.0001 |
| Blood culture positive* | 58 (2.8%) | 40 (2.0%) | 18 (18.6%) | <0.0001 |
| Probable pathogen* | 74 (3.5%) | 24 (1.2%) | 50 (51.5%) | <0.0001 |
| Type of probable pathogen* | ||||
| CONS | 14 (0.7%) | 3 (0.1%) | 11 (11.3%) | <0.0001 |
| Enterococcus | 3 (0.1%) | 2 (0.1%) | 1 (1.0%) | |
| Gram-negative Bacillus | 10 (0.5%) | 5 (0.2%) | 5 (5.2%) | |
| MRSA | 10 (0.5%) | 1 (0.0%) | 9 (9.3%) | |
| MSSA | 12 (0.6%) | 2 (0.1%) | 10 (10.3%) | |
| Pseudomonas aeruginosa | 5 (0.2%) | 1 (0.0%) | 4 (4.1%) | |
| Polymicrobial | 12 (0.6%) | 5 (0.2%) | 7 (7.2%) | |
| Streptococcal sp. | 6 (0.3%) | 4 (0.2%) | 2 (2.1%) | |
| Candida sp. | 2 (0.1%) | 1 (0.0%) | 1 (1.0%) | |
| Therapeutic Variablesa | ||||
| Any antibiotic post-procedure (>72 h)b | 978 (46.4%) | 884 (44.0%) | 94 (96.9%) | <0.0001 |
| Antibiotic from limited list post-procedure (>72 h) | 880 (41.8%) | 786 (39.1%) | 94 (96.9%) | <0.0001 |
| Type of antibiotic post-procedure (>72 h)c | ||||
| Amoxicillin | 209 (9.9%) | 187 (9.3%) | 22 (22.7%) | <0.0001 |
| Atovaquone | 1 (0.0%) | 0 (0.0%) | 1 (1.0%) | 0.046 |
| Cefazolin | 64 (3.0%) | 54 (2.7%) | 10 (10.3%) | <0.0001 |
| Cefepime | 59 (2.8%) | 50 (2.5%) | 9 (9.3%) | <0.0001 |
| Ceftriaxone | 108 (5.1%) | 93 (4.6%) | 15 (15.5%) | <0.0001 |
| Cephalexin | 184 (8.7%) | 148 (7.4%) | 36 (37.1%) | <0.0001 |
| Ciprofloxacin | 220 (10.4%) | 197 (9.8%) | 23 (23.7%) | <0.0001 |
| Clindamycin | 68 (3.2%) | 61 (3.0%) | 7 (7.2%) | 0.023 |
| Doxycycline | 123 (5.8%) | 109 (5.4%) | 14 (14.4%) | 0.0002 |
| Linezolid | 13 (0.6%) | 10 (0.5%) | 3 (3.1%) | 0.019 |
| Minocycline | 19 (0.9%) | 14 (0.7%) | 5 (5.2%) | <0.0001 |
| Nafcillin | 7 (0.3%) | 4 (0.2%) | 3 (3.1%) | 0.0029 |
| Rifampin | 8 (0.4%) | 3 (0.1%) | 5 (5.2%) | <0.0001 |
| Trimethoprim-Sulfamethoxazole | 107 (5.1%) | 85 (4.2%) | 22 (22.7%) | <0.0001 |
| Vancomycin | 274 (13.0%) | 215 (10.7%) | 59 (60.8%) | <0.0001 |
| Billing Code Variables | ||||
| Surgical Site Infection code | 184 (8.7%) | 111 (5.5%) | 73 (75.3%) | <0.0001 |
| General infection code | 143 (6.8%) | 109 (5.4%) | 34 (35.1%) | <0.0001 |
| Material infection code | 2 (0.1%) | 2 (0.1%) | 0 (0.0%) | >0.99 |
| CPT infection code | 1,726 (81.9%) | 1,648 (82.0%) | 78 (80.4%) | 0.69 |
Abbreviations: ICD = Implantable Cardioverter-Defibrillator, ID = Infectious Disease, CPT = current procedural terminology, CONS = Coagulase-negative Staphylococcus, MRSA = Methicillin-resistant Staphylococcus aureus, MSSA = Methicillin susceptible Staphylococcus aureus.
*Identified from manual review.
aAntibiotic use only after a 72-hour window period following the index CIED procedure was applied given the frequent use of prophylactic antibiotics peri-procedure.
bLimited List of antibiotics in Supplementary Note S3.
cThere was no significant difference in frequency of the following antimicrobial prescriptions between the two groups: Ampicillin, Ampicillin/sulbactam, Azithromycin, Cefpodoxime, Cefprozil, Cefuroxime, Clarithromycin, Dapsone, Demeclocycline, Dicloxacillin, Erythromycin, Gentamicin, Levofloxacin, Metronidazole, Moxifloxacin, Penicillin, Rifaximin, Tetracycline.