Abstract
Background: Cardiac implantable electronic devices (CIEDs) substantially improve outcomes in cardiac patients, but device-related infection can negate these benefits. Data on the epidemiology of CIED infections in Saudi Arabia are limited. Methods: We performed a multicenter retrospective cohort study of consecutive patients receiving CIEDs (pacemakers [PPM], implantable cardioverter-defibrillators [ICD], and cardiac resynchronization devices [CRT]) at three tertiary hospitals in Riyadh, Saudi Arabia, from January 2017 through December 2021. Patients were followed for at least one year post-implantation. Data collected included patient demographics, device type (new implant, replacement, revision), infection timing and microbiology, management (device extraction vs conservative treatment), and outcomes. Results: Of 4080 CIED recipients, 114 (2.8%) developed device infections (incidence 98.8 per 10,000 person-years). CRT-P (cardiac resynchronization therapy pacemaker) devices had the highest infection rate (7.7%). Revision procedures carried higher infection rates than initial implants or generator replacements (10.0% vs 2.1% vs 2.7%; P < .001). The most common pathogens were Staphylococcus aureus (30.1%), coagulase-negative staphylococci (10.6%), and Pseudomonas aeruginosa (8.8%); 38.9% of infections were culture-negative. Systemic infections and patients managed without device removal had significantly higher mortality (32.3% vs 8.2% for systemic vs pocket; 48.4% vs 12.0% for no extraction vs extraction; P < .001 for both). Conclusions: In this large Saudi cohort, CIED infection occurred in 2.8% of patients, particularly following revision procedures and in CRT-P recipients. Infections were often culture-negative and associated with substantial mortality, especially in systemic cases or when devices were not removed. These findings highlight the importance of strict infection-prevention protocols, early recognition, and prompt complete device extraction to improve patient outcomes.
Recommended Citation
Albogami, Saad; Alqarawi, Wael; Alfagih, Ahmed; Alenzi, Hiatham; Alshehri, Mohammad; Aljuaid, Mossab; Alqahtani, Saeed; Alswaidan, Norah; Alharbi, Mohammad; Alkaltham, Norah; Alasmri, Lama; Sadkh, Rghd; Albashari, Muna; Alhouda, Nour; and Tleyjeh, Imad
(2025)
"Cardiac Implantable Electronic Device Infections in Saudi Arabia: Incidence, Timing, Causative Organisms, and Outcomes – A Multicenter Study,"
Journal of the Saudi Heart Association: Vol. 37
:
Iss.
4
, Article 20.
Available at: https://doi.org/10.37616/2212-5043.1468
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.
