Pacemaker related endocarditis: analysis of seven cases.
Vegetative electrode infection following permanent pacemaker implantation is a rare and serious complication. Among 1920 patients who underwent permanent pacemaker implantation in our institute between 1980 and 2000, 7 patients aged 65 to 78 years were diagnosed to have pacemaker related endocarditis. In this study, the clinical course and management strategies for these patients are reviewed. The most frequently encountered factors contributing to development of pacemaker infection were local complications such as postoperative hematoma and inflammation, and recurrent surgical interventions on the pacemaker system. In blood cultures S. aureus was the most common causative microorganism. Echocardiography could be performed in 5 patients. Three patients were referred to open-heart surgery for total removal of the pacemaker system, and one patient had his pacemaker system removed percutaneously. The remaining 3 patients did not agree to either surgical or percutaneous removal. These patients have been under antibiotic therapy for approximately 3 years and they still do not have any signs of a serious infection. Consequently, in patients with permanent pacemakers, infective endocarditis should be considered in the presence of fever and local symptoms. Blood cultures should be obtained and echocardiography should be performed. Complete removal of the pacemaker system with intensive antibiotic treatment is necessary for complete eradication of the infection. However, if percutaneous or surgical removal of the electrodes cannot be done because of high perioperative risk or the patient does not agree to undergo either method, medical treatment with long term antibiotic use may be considered as an alternative.
Erdinler
Izzet
I
Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Florence Nightingale Hospital, Istanbul, Turkey.
Okmen
Ertan
E
Zor
Utku
U
Zor
Aysegul
A
Oguz
Enis
E
Ketenci
Bulent
B
Akyol
Ahmet
A
Aytekin
Saide
S
Ulufer
Tanju
T
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D020878:Device Removal; D017548:Echocardiography, Transesophageal; D004567:Electrodes, Implanted / Q000009:adverse effects; D004697:Endocarditis, Bacterial / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D013203:Staphylococcal Infections / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D013211:Staphylococcus aureus; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents