title: Frequency of permanent pacemaker or implantable cardioverter-defibrillator infection in patients with gram-negative bacteremia.
abstract: BACKGROUND
  Despite the frequent occurrence of bacteremia due to gram-negative organisms in patients with underlying permanent pacemakers (PPMs) or implantable cardioverter defibrillators (ICDs), the outcome and treatment of these patients has received scant attention. In patients with PPMs or ICDs who have Staphylococcus aureus bacteremia, 45% have PPM/ICD infection.
  
  
  METHODS
  We conducted a retrospective cohort study over a 7-year period to assess the clinical features and frequency of PPM/ICD infection in patients with gram-negative bacteremia, as well as the incidence of relapse in patients for whom the device was not removed.
  
  
  RESULTS
  Forty-nine patients were included in the study; 3 (6%) had either definite (2 patients) or possible (1 patient) PPM/ICD infection. Both patients with definite PPM/ICD infection had clear infection of the generator pocket. None of the other patients with alternate sources of bacteremia developed PPM/ICD infection. Thirty-four patients with retained PPM/ICD were observed for >12 weeks (median time, 759 days), and 2 (6%) developed relapsing bacteremia, although they each had alternative sources of relapse.
  
  
  CONCLUSIONS
  In sharp contrast to S. aureus infection, PPM/ICD infection in patients with gram-negative bacteremia was rare, and no patients appeared to have secondary PPM/ICD infection due to hematogenous seeding of the system. Despite infrequent system removal in these patients, relapsing bacteremia among patients who survived initial bacteremia was rarely seen. If secondary PPM/ICD infection occurs in patients with gram-negative bacteremia, it is either uncommon or it is cured with antimicrobial therapy despite device retention.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905, USA. uslan.daniel@mayo.edu
authors.forename: Daniel Z
authors.initials: DZ
authors.lastname: Uslan
authors.forename: Muhammad R
authors.initials: MR
authors.lastname: Sohail
authors.forename: Paul A
authors.initials: PA
authors.lastname: Friedman
authors.forename: David L
authors.initials: DL
authors.lastname: Hayes
authors.forename: Walter R
authors.initials: WR
authors.lastname: Wilson
authors.forename: James M
authors.initials: JM
authors.lastname: Steckelberg
authors.forename: Larry M
authors.initials: LM
authors.lastname: Baddour
mesh_terms: D000368:Aged; D016470:Bacteremia / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology; D015331:Cohort Studies; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000150:complications* / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D012008:Recurrence; D012189:Retrospective Studies