Skip to main content
PMC home page
Clinical Cardiology logoLink to Clinical Cardiology
. 2010 Jul 13;33(7):406–411. doi: 10.1002/clc.20765

Permanent Pacemaker and Implantable Cardioverter Defibrillator Infections: Seven Years of Diagnostic and Therapeutic Experience of a Single Center

Mustafa Cengiz 1, Sercan Okutucu 2,✉, Sibel Ascioglu 1,3, Abdurrahman Şahin 1, Hakan Aksoy 2, Onur Sinan Deveci 2, Ergun Baris Kaya 2, Kudret Aytemir 2, Giray Kabakci 2, Lale Tokgozoglu 2, Hilmi Ozkutlu 2, Ali Oto 2
PMCID: PMC6653156  PMID: 20641117

Abstract

Background

Increasing evidence‐based indications for the implantation of permanent pacemakers (PMs) and implantable cardioverter defibrillators (ICDs) have led to an increase in the rate of device infections. The aim of the present study was to evaluate infection frequency, clinical characteristics, risk factors, and microbiologic and therapeutic features in patients with PM/ICD infections.

Hypothesis

Clinical and demographic characteristics of the patients can affect the PM/ICD infections.

Methods

The PM/ICD infection group consisted of 57 patients diagnosed and treated with PM/ICD infections in our hospital. The control group in this case‐control study consisted of 833 patients in whom a PM or ICD had been implanted and no infections were noted.

Results

Patients with PM/ICD infections (median age 65 years; range, 18–104 years) were older than those without PM/ICD infections (median age 58 years; range, 18–86 years; P = 0.005). The percentage of generator replacement was higher in the PM/ICD infection group compared with the control group (16% vs 8%, P = 0.003). Independent predictors of PM/ICD infections were advanced age (>60 years; odds ratio [OR]: 2.5, 95% confidence interval [CI]: 1.2–4.0, P = 0.021) and device revision (OR: 3.8, 95% CI: 1.5–5.5, P = 0.002). Primary antibiotic prophylaxis during the procedure reduced the risk for PM/ICD infection (OR: 0.5, 95% CI: 0.4–0.8, P = 0.011).

Conclusions

PM/ICD infections occur in a significant number of patients. It is important to be aware of the risk factors for PM/ICD infections so that patients with an increased risk can be identified and preventive measures can be implemented. Copyright © 2010 Wiley Periodicals, Inc.

Full Text

The Full Text of this article is available as a PDF (179.6 KB).

References

  • 1. Karchmer AW, Longworth DL. Infections of intracardiac devices. Infect Dis Clin North Am 2002; 16: 477–505, xii. [DOI] [PubMed] [Google Scholar]
  • 2. Uslan DZ, Sohail MR, St Sauver JL, et al. Permanent pacemaker and implantable cardioverter defibrillator infection: a population‐based study. Arch Intern Med 2007; 167: 669–75. [DOI] [PubMed] [Google Scholar]
  • 3. Cabell CH, Heidenreich PA, Chu VH, et al. Increasing rates of cardiac device infections among Medicare beneficiaries: 1990–1999. Am Heart J 2004; 147: 582–586. [DOI] [PubMed] [Google Scholar]
  • 4. Camus C, Leport C, Raffi F, et al. Sustained bacteremia in 26 patients with a permanent endocardial pacemaker: assessment of wire removal. Clin Infect Dis 1993; 17: 46–55. [DOI] [PubMed] [Google Scholar]
  • 5. Klug D, Lacroix D, Savoye C, et al. Systemic infection related to endocarditis on pacemaker leads: clinical presentation and management. Circulation 1997; 95: 2098–2107. [DOI] [PubMed] [Google Scholar]
  • 6. Gandelman G, Frishman WH, Wiese C, et al. Intravascular device infections: epidemiology, diagnosis, and management. Cardiol Rev 2007; 15: 13–23. [DOI] [PubMed] [Google Scholar]
  • 7. Chua JD, Wilkoff BL, Lee I, et al. Diagnosis and management of infections involving implantable electrophysiologic cardiac devices. Ann Intern Med 2000; 133: 604–608. [DOI] [PubMed] [Google Scholar]
  • 8. Lewis AB, Hayes DL, Holmes DR Jr, et al. Update on infections involving permanent pacemakers. Characterization and management. J Thorac Cardiovasc Surg 1985; 89: 758–763. [PubMed] [Google Scholar]
  • 9. Bracker F. Pacemaker lead complications: when is extraction appropriate and what can we learn from published data? Heart 2001; 85: 254–259. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10. Cacoub P, Leprince P, Nataf P, et al. Pacemaker infective endocarditis. Am J Cardiol 1998; 82: 480–484. [DOI] [PubMed] [Google Scholar]
  • 11. Klug D, Balde M, Pavin D, et al; for PEOPLE Study Group. Risk factors related to infections of implanted pacemakers and cardioverter‐defibrillators: results of a large prospective study. Circulation 2007; 116: 1349–1355. [DOI] [PubMed] [Google Scholar]
  • 12. Del R´ıo A, Anguera I, Miró JM, et al. Surgical treatment of pacemaker and defibrillator lead endocarditis: the impact of electrode lead extraction on outcome. Chest 2003; 124: 1451–1459. [DOI] [PubMed] [Google Scholar]
  • 13. Li JS, Sexton DJ, Mick N, et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis 2000; 30: 633–638. [DOI] [PubMed] [Google Scholar]
  • 14. Voigt A, Shalaby A, Saba S. Rising rates of cardiac rhythm management device infections in the United States: 1996 through 2003. J Am Coll Cardiol 2006; 48: 590–591. [DOI] [PubMed] [Google Scholar]
  • 15. Conklin EF, Giannelli S Jr, Nealon TF Jr. Four hundred consecutive patients with permanent transvenous pacemakers. J Thorac Cardiovasc Surg 1975; 69: 1–7. [PubMed] [Google Scholar]
  • 16. Bluhm G. Pacemaker infections. A clinical study with special reference to prophylactic use of some isoxazolyl penicillins. Acta Med Scand Suppl 1985; 699: 1–62. [PubMed] [Google Scholar]
  • 17. Catanchin A, Murdock CJ, Athan E. Pacemaker infections: a 10‐year experience. Heart Lung Circ 2007; 16: 434–439. [DOI] [PubMed] [Google Scholar]
  • 18. Mounsey JP, Griffith MJ, Tynan M, et al. Antibiotic prophylaxis in permanent pacemaker implantation: a prospective randomised trial. Br Heart J 1994; 72: 339–343. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19. León AR, Abraham WT, Curtis AB, et al. Safety of transvenous cardiac resynchronization system implantation in patients with chronic heart failure: combined results of over 2,000 patients from a multicenter study program. J Am Coll Cardiol 2005; 46: 2348–2356. [DOI] [PubMed] [Google Scholar]
  • 20. Duval X, Selton‐Suty C, Alla F, et al. Endocarditis in patients with a permanent pacemaker: a 1‐year epidemiological survey on infective endocarditis due to valvular and/or pacemaker infection. Clin Infect Dis 2004; 39: 68–74. [DOI] [PubMed] [Google Scholar]
  • 21. Lekkerkerker JC, van Nieuwkoop C, Trines SA, et al. Risk factors and time delay associated with cardiac device infections: Leiden device registry. Heart 2009; 95: 715–720. [DOI] [PubMed] [Google Scholar]
  • 22. Kleemann T, Becker T, Strauss M, et al. Prevalence of bacterial colonization of generator pockets in implantable cardioverter defibrillator patients without signs of infection undergoing generator replacement or lead revision. Europace 2010; 12: 58–63. [DOI] [PubMed] [Google Scholar]
  • 23. Baddour LM, Bettmann MA, Bolger AF, et al. Nonvalvular cardiovascular device‐related infections. Circulation 2003; 108: 2015–2031. [DOI] [PubMed] [Google Scholar]
  • 24. Sohail MR, Uslan DZ, Khan AH, et al. Risk factor analysis of permanent pacemaker infection. Clin Infect Dis 2007; 45: 166–173. [DOI] [PubMed] [Google Scholar]
  • 25. Bertaglia E, Zerbo F, Zardo S, Barzan D, Zoppo F, Pascotto P. Antibiotic prophylaxis with a single dose of cefazolin during pacemaker implantation: incidence of long‐term infective compli‐cations. Pacing Clin Electrophysiol 2006; 29: 29–33. [DOI] [PubMed] [Google Scholar]
  • 26. Chinn R, Dembitsky W, Eaton L, et al. Multicenter experience: prevention and management of left ventricular assist device infections. ASAIO J 2005; 51: 461–470. [DOI] [PubMed] [Google Scholar]
  • 27. Da Costa A, Kirkorian G, Cucherat M, et al. Antibiotic prophylaxis for permanent pacemaker implantation: a meta‐analysis. Circulation 1998; 97: 1796–1801. [DOI] [PubMed] [Google Scholar]
  • 28. Ellis ME, Al‐Abdely H, Sandridge A, Greer W, Ventura W. Fungal endocarditis: evidence in the world literature, 1965–1995. Clin Infect Dis 2001; 32: 50–62. [DOI] [PubMed] [Google Scholar]
  • 29. Daniel WG, Mügge A. Transesophageal echocardiography. N Engl J Med 1995; 332: 1268–1279. [DOI] [PubMed] [Google Scholar]

Articles from Clinical Cardiology are provided here courtesy of Wiley

RESOURCES