title: Diagnosis and management of infections involving implantable electrophysiologic cardiac devices.
abstract: BACKGROUND
  Optimal treatment of infections related to implantable electrophysiologic cardiac devices is poorly defined.
  
  
  OBJECTIVE
  To describe the clinical presentation, treatment, and outcome of patients with such infections.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  The Cleveland Clinic Foundation, Cleveland, Ohio.
  
  
  METHODS
  123 patients with infections involving implantable cardiac electrophysiologic devices.
  
  
  METHODS
  Demographic characteristics, clinical manifestations, time to diagnosis, management, and outcome.
  
  
  RESULTS
  87 patients with permanent pacemakers and 36 patients with implantable cardioverter defibrillators had infections. The most common signs and symptoms were pocket erythema and local pain. The most common pathogens were coagulase-negative staphylococci (68%) and Staphylococcus aureus (23%). In 117 patients (95%), all equipment was extracted and antibiotic therapy lasted a median of 28 days. Operative mortality was zero. Follow-up showed crude mortality and relapse rates of 8% and 3%, respectively.
  
  
  CONCLUSIONS
  For infections related to implantable electrophysiologic devices, complete device removal and antimicrobial therapy allow timely, successful reimplantation at a remote anatomic site without substantial risk for operative mortality or recurrent infection.
authors.affiliation: Department of Infectious Disease, S32, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
authors.forename: J D
authors.initials: JD
authors.lastname: Chua
authors.forename: B L
authors.initials: BL
authors.lastname: Wilkoff
authors.forename: I
authors.initials: I
authors.lastname: Lee
authors.forename: N
authors.initials: N
authors.lastname: Juratli
authors.forename: D L
authors.initials: DL
authors.lastname: Longworth
authors.forename: S M
authors.initials: SM
authors.lastname: Gordon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000209:etiology; D001424:Bacterial Infections / Q000188:drug therapy / Q000209:etiology*; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D012086:Reoperation; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000209:etiology; D013211:Staphylococcus aureus; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents