Cardiac Implantable Electronic Device Infections in Saudi Arabia: Incidence, Timing, Causative Organisms, and Outcomes - A Multicenter Study.

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 < 0.001). 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 < 0.001 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.