title: Permanent pacemaker and implantable cardioverter defibrillator infection: a population-based study.
abstract: BACKGROUND
  The incidence of cardiac device infection is not well understood. Bloodstream infection (BSI) in patients with permanent pacemakers or implantable cardioverter-defibrillators (hereafter, defibrillators) may reflect device infection.
  
  
  METHODS
  Retrospective, population-based cohort study of all adult patients with cardiac devices who resided in Olmsted County, Minnesota, from 1975 to 2004. The medical linkage-system of the Rochester Epidemiology Project and standardized criteria were used to identify all cases of BSI and device infection. The incidence of device infection was calculated with person-years of follow-up after device implantation.
  
  
  RESULTS
  A total of 1524 patients with cardiac devices were included in the cohort. Total person-time of follow-up was 7578 years. The incidence of definite device infection was 1.9 per 1000 device-years (95% confidence interval [CI], 1.1-3.1). The incidence of pocket infection without BSI was 1.37 per 1000 device-years (95% CI, 0.62-3.05), and pocket infection with BSI or device-related endocarditis 1.14 per 1000 device years (95% CI, 0.47-2.74). The cumulative probability of device infection was higher among patients with defibrillators compared with those with pacemakers, P<.001. Twelve (54.6%) of 22 cases of Staphylococcus aureus BSI had definite or possible cardiac device infection vs 3 (12.0%) of 25 cases of bloodstream infection due to gram-negative bacilli (P = .004).
  
  
  CONCLUSIONS
  To our knowledge, this is the first population-based study to describe the incidence of cardiac device infection. Device infection was common during episodes of S aureus BSI. The rate of cardiac device infection was higher in patients with defibrillators than in those with pacemakers.
authors.affiliation: Department of Medicine, Division of Infectious Diseases, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA. duslan@mednet.ucla.edu
authors.forename: Daniel Z
authors.initials: DZ
authors.lastname: Uslan
authors.forename: Muhammad R
authors.initials: MR
authors.lastname: Sohail
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: St Sauver
authors.forename: Paul A
authors.initials: PA
authors.lastname: Friedman
authors.forename: David L
authors.initials: DL
authors.lastname: Hayes
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Stoner
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; D001424:Bacterial Infections / Q000453:epidemiology / Q000209:etiology*; D015331:Cohort Studies; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D016459:Prosthesis-Related Infections / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies