Infective endocarditis complicating permanent pacemaker and implantable cardioverter-defibrillator infection.
OBJECTIVE
To describe management of patients with permanent pacemaker (PPM)- and implantable cardioverter-defibrillator (ICD)-related endocarditis.


METHODS
We retrospectively reviewed all cases of infection involving PPMs and ICDs among patients presenting to Mayo Clinic's site in Rochester, MN, between January 1, 1991, and December 31, 2003. Cardiac device-related infective endocarditis (CDIE) was defined as the presence of both vegetation on a device lead or valve and clinical or microbiological evidence of CDIE. Of 189 patients with PPM or ICD infection who were admitted during the study period, 44 met the case definition for CDIE (33 PPM, 11 ICD).


RESULTS
The mean +/- SD age of patients was 67 +/- 14 years. Staphylococci (36 [82%]) were the most commonly isolated pathogens. Nearly all patients (43 [98%]) were treated with a combined approach of complete hardware removal and parenteral antibiotics. The median duration of antibiotic treatment after infected device explantation was 28 days (interquartile range, 19-42 days). Device leads were removed percutaneously in 34 cases (77%); only 7 cases (16%) required surgical lead extraction. Percutaneous extraction was uncomplicated in 15 patients with lead vegetation greater than 10 mm in diameter. Six patients (14%) died during hospitalization. Twenty-seven (96%) of 28 patients remained infection free at their last visit (median follow-up, 183 days; intraquartile range, 36-628 days).


CONCLUSIONS
Prompt hardware removal and prolonged parenteral antibiotic administration decrease mortality among patients with CDIE. The presence of a large (> 10 mm in diameter) vegetation on a lead is not a contraindication for percutaneous lead extraction.
Sohail
Muhammad R
MR
Department of Medicine, Tawam Hospital-Johns Hopkins Medicine, P.O. Box 15258, Al Ain, Abu Dhabi, United Arab Emirates. msohail@tawamhosp.gov.ae
Uslan
Daniel Z
DZ
Khan
Akbar H
AH
Friedman
Paul A
PA
Hayes
David L
DL
Wilson
Walter R
WR
Steckelberg
James M
JM
Jenkins
Sarah M
SM
Baddour
Larry M
LM
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D015331:Cohort Studies; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D020878:Device Removal; D004696:Endocarditis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents