Staphylococcus aureus bacteremia in patients with permanent pacemakers or implantable cardioverter-defibrillators.
BACKGROUND
Although cardiac device infections (CDIs) are a devastating complication of permanent pacemakers or implantable cardioverter-defibrillators, the incidence of CDI in patients with bacteremia is not well defined. The objective of this study was to determine the incidence of CDI among patients with permanent pacemakers or implantable cardioverter-defibrillators who develop Staphylococcus aureus bacteremia (SAB).


RESULTS
A cohort of all adult patients with SAB and permanent pacemakers or implantable cardioverter-defibrillators over a 6-year period was evaluated prospectively. The overall incidence of confirmed CDI was 15 of 33 (45.4%). Confirmed CDI occurred in 9 of the 12 patients (75%) with early SAB (<1 year after device placement). Fifteen of 21 patients (71.5%) with late SAB (>/=1 year after device placement) had either confirmed (6 of 21, 28.5%) or possible (9 of 21, 43%) CDI. In 60% of the patients (9 of 15) with confirmed CDI, no local signs or symptoms suggesting generator pocket infection were noted.


CONCLUSIONS
The incidence of CDI among patients with SAB and cardiac devices is high. Neither physical examination nor echocardiography can exclude the possibility of CDI. In patients with early SAB, the device is usually involved, and approximately 40% of these patients have obvious clinical signs of cardiac device involvement. Conversely, in patients with late SAB, the cardiac device is rarely the initial source of bacteremia, and there is a paucity of local signs of device involvement. The cardiac device is involved, however, in >/=28% of these patients.
Chamis
A L
AL
Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA.
Peterson
G E
GE
Cabell
C H
CH
Corey
G R
GR
Sorrentino
R A
RA
Greenfield
R A
RA
Ryan
T
T
Reller
L B
LB
Fowler
V G
VG
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000628:therapy; D015331:Cohort Studies; D017147:Defibrillators, Implantable / Q000009:adverse effects; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents