[Secondary infections after pacemaker implantation].
BACKGROUND
Infectious complications following pacemaker implantation are not common but may be particularly severe. Localized wound infections at the site of implantation have been reported in 0.5% of the cases in the most recent series, with an average of about 2%. The incidence of septicemia and infectious endocarditis is lower, about 0.5% of the cases. The operator's experience, the duration of the procedure and repeat procedures are considered to be predisposing factors.


BACKGROUND
The main cause of these infections has been recently demonstrated to be local contamination during implantation. The commonest causal organism is Staphylococcus (75 to 92% of the cases), Staphylococcus aureus being the cause of acute infections (less than 6 weeks), whereas Staphylococcus epidermidis is associated with cases of secondary infection (more than 2 months). The usual clinical presentation is infection at the site of the pacemaker but other forms such as abscess, endocarditis, rejection of the implanted material, septic emboli or phlebitis have been described. The diagnosis is confirmed by local and systemic biological investigations and by echocardiography (especially transesophageal echocardiography) in cases of right heart endocarditis. There are two axes of treatment: bactericidal double antibiotherapy and surgical ablation of the infected material either percutaneously or by cardiotomy.


CONCLUSIONS
A recent meta-analysis supported the role of systematic, preoperative, prophylactic antibiotic therapy in the prevention of these complications. These data should be confirmed by suitably powered clinical trials.
Da Costa
A
A
Service de cardiologie, hôpital Nord, CHRU, Saint-Etienne, France.
Kirkorian
G
G
Isaaz
K
K
Touboul
P
P
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D015984:Causality; D003428:Cross Infection / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control*; D004696:Endocarditis / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control*; D005260:Female; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods*; D008297:Male; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D015995:Prevalence; D011379:Prognosis; D018805:Sepsis / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control*; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control*; D013997:Time Factors; D014946:Wound Infection / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control*
D000900:Anti-Bacterial Agents