Pacemaker infections: a 10-year experience.
BACKGROUND
Infection is a major complication of pacemaker and defibrillator (PPM/ICD) implantation. The experience in an Australian regional centre is reported.


METHODS
Ten years' (1994-2004) cases of PPM/ICD infection retrospectively analysed and compared to overall insertion data; management and outcomes examined.


RESULTS
A total 39 cases (79.5% male, median age 71.3 years) identified, 24 in the primary centre where 1481 procedures performed (infection rate 1.6%). Patients with infection had average 2.2 procedures performed (odds ratio for infection if >1 procedure=4.7); 14 (36%) first implantations, 35 (90%) pacemakers, 11 (28%) recurrent. No difference in operation duration or difficulty between infected and non-infected cases. Infection in 18 cases (46%) involved lead/s, 16 (41%) generator and 5 (13%) both. Median time to presentation was 7.9 months. Echocardiography demonstrated lead vegetations in 8 cases. Organisms identified in 25 (64%)-92% Staphylococci (65% S. aureus); blood cultures positive in 18. PPM/ICD removed in 26 (67%), including lead/s in 89%; average hospital stay 37 days. One death attributable to PPM/ICD infection (mortality 2.6%), median follow-up 29.3 months.


CONCLUSIONS
A PPM/ICD infection rate of 1.6% (endocarditis 0.3%) demonstrated. Second and subsequent procedures carried almost 5 times greater infection risk.
Catanchin
Andrei
A
Department of Cardiology, Barwon Health (Geelong Hospital), Geelong, Vic. 3220, Australia. andrei.catanchin@gmail.com
Murdock
Challon J
CJ
Athan
Eugene
E
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D017147:Defibrillators, Implantable / Q000009:adverse effects* / Q000382:microbiology*; D004452:Echocardiography; D004697:Endocarditis, Bacterial / Q000453:epidemiology* / Q000209:etiology* / Q000382:microbiology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects* / Q000382:microbiology*; D011183:Postoperative Complications; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology*; D013211:Staphylococcus aureus