title: The oral cavity is not a primary source for implantable pacemaker or cardioverter defibrillator infections.
abstract: BACKGROUND
  To test the hypothesis that the oral cavity is a potential source for implantable pacemaker and cardioverter defibrillators infections, the bacterial diversity on explanted rhythm heart management devices was investigated and compared to the oral microbiome.
  
  
  METHODS
  A metagenomic approach was used to analyze the bacterial diversity on the surfaces of non-infected and infected pacemakers. The DNA from surfaces swaps of 24 non-infected and 23 infected pacemaker were isolated and subjected to bacterial-specific DNA amplification, single strand conformation polymorphism- (SSCP) and sequencing analysis. Species-specific primer sets were used to analyze for any correlation between bacterial diversity on pacemakers and in the oral cavity.
  
  
  RESULTS
  DNA of bacterial origin was detected in 21 cases on infected pacemakers and assigned to the bacterial phylotypes Staphylococcus epidermidis, Propionibacterium acnes, Staphylococcus aureus, Staphylococcus schleiferi and Stapyhlococcus. In 17 cases bacterial DNA was found on pacemakers with no clinical signs of infections. On the basis of the obtained sequence data, the phylotypes Propionibacterium acnes, Staphylococcus and an uncultured bacterium were identified. Propionibacterium acnes and Staphylococcus epidermidis were the only bacteria detected in pacemeaker (n = 25) and oral samples (n = 11).
  
  
  CONCLUSIONS
  The frequency of the coincidental detection of bacteria on infected devices and in the oral cavity is low and the detected bacteria are highly abundant colonizers of non-oral human niches.The transmission of oral bacteria to the lead or device of implantable pacemaker or cardioverter defibrillators is unlikely relevant for the pathogenesis of pacemaker or cardioverter defibrillators infections.
authors.affiliation: Department of Prosthetic Dentistry and Biomedical Material Sciences, Hannover Medical School, Carl-Neuberg-Str, 1, Hannover 30625, Germany. eberhard.joerg@mh-hannover.de
authors.forename: Jörg
authors.initials: J
authors.lastname: Eberhard
authors.forename: Nico
authors.initials: N
authors.lastname: Stumpp
authors.forename: Fadi
authors.initials: F
authors.lastname: Ismail
authors.forename: Ulrike
authors.initials: U
authors.lastname: Schnaidt
authors.forename: Wieland
authors.initials: W
authors.lastname: Heuer
authors.forename: Maximilian
authors.initials: M
authors.lastname: Pichlmaier
authors.forename: Christian
authors.initials: C
authors.lastname: Kühn
authors.forename: Axel
authors.initials: A
authors.lastname: Haverich
authors.forename: Meike
authors.initials: M
authors.lastname: Stiesch
mesh_terms: D000368:Aged; D018441:Biofilms; D004269:DNA, Bacterial / Q000032:analysis / Q000302:isolation & purification; D047548:Defibrillators / Q000382:microbiology*; D005260:Female; D006801:Humans; D008297:Male; D056186:Metagenomics; D009055:Mouth / Q000382:microbiology*; D010138:Pacemaker, Artificial / Q000382:microbiology*; D011425:Propionibacterium acnes / Q000235:genetics / Q000302:isolation & purification; D016459:Prosthesis-Related Infections / Q000382:microbiology*; D013210:Staphylococcus / Q000235:genetics / Q000302:isolation & purification
chemical_list: D004269:DNA, Bacterial