Undertreatment and overtreatment of patients with infected antiarrhythmic implantable devices.
BACKGROUND
Infection of implantable defibrillators or pacemakers is a serious complication, reported with increasing frequency probably because of an increase in the total number of devices implanted due to a change in trends in the treatment of arrhythmias. This review is aimed to provide guidelines on how to deal with these infections and which method is most likely to be successful.


METHODS
This is a review of 38 patients with infected antiarrhythmic implantable devices under three different plans of therapy. There were 17 implantable cardioverter defibrillators and 21 pacemakers. In 27, infection occurred after primary implantation (15 pacers, 12 implantable cardioverter defibrillators), and in 11 after replacement (six pacers, five implantable cardioverter defibrillators). Three therapeutic plans were identified. Group I (n = 12) received intravenous antibiotics without removal of the antiarrhythmic implantable device, but with relocation to a different area or plane, and with or without the use of a topical irrigating-suction system. Group II (n = 19) had complete removal of the system, 2 weeks of intravenous antibiotics, and implantation of a new unit followed by 10 more days of antibiotics. Group III (n = 7) underwent complete removal, 6 weeks of antibiotics, implantation of a new unit, and another 6 or more weeks of antibiotic therapy.


RESULTS
Failure occurred in 100% of cases in group I. Groups II and III had complete clearing of infection and successful reimplantation of new systems with no recurring infections. Follow-up was 8 months to 5 years. Two deaths occurred, both in group I. Hospitalization for groups I and III was 104 days and 65 days, respectively, versus 22 days for group II. No deaths occurred in group II or III.


CONCLUSIONS
With an infected antiarrhythmic implantable device, immediate removal of the entire unit is recommended, followed by 2 weeks of intravenous antibiotics, implantation of a new system, and 10 more days of postoperative antibiotics. This regimen is sufficient to cure the problem. No attempts should be made to save an infected system from removal because it endangers the patient's life, prolongs hospitalization, increases costs, and most likely will fail.
Molina
J E
JE
Division of Cardiovascular and Thoracic Surgery, University of Minnesota, Minneapolis 55455, USA.
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D017147:Defibrillators, Implantable; D006801:Humans; D007223:Infant; D008875:Middle Aged; D010138:Pacemaker, Artificial; D011183:Postoperative Complications / Q000188:drug therapy / Q000382:microbiology / Q000628:therapy*; D012189:Retrospective Studies; D018805:Sepsis / Q000628:therapy; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000628:therapy*
D000900:Anti-Bacterial Agents