Diagnosis and Management of Infections Involving Implantable Electrophysiologic Cardiac Devices

Diagnosis and Management of Infections Involving Implantable Electrophysiologic Cardiac Devices

Presented in part at the Eighth Annual Scientific Meeting of the Society for Health Care Epidemiology of America, Orlando, Florida, 5–7 April 1998 (abstract no. S18); the 36th Annual Meeting of the Infectious Diseases Society of America, Denver, Colorado, 12–15 November 1998 (abstract no. 623); and the 20th Session of the North American Society of Pacing and Electrophysiology, Toronto, Canada, 12–15 May 1999 (abstract no. 315).

Abstract

Background: Optimal treatment of infections related to implantable electrophysiologic cardiac devices is poorly defined.

Objective: To describe the clinical presentation, treatment, and outcome of patients with such infections.

Design: Retrospective case series.

Setting: The Cleveland Clinic Foundation, Cleveland, Ohio.

Patients: 123 patients with infections involving implantable cardiac electrophysiologic devices.

Measurements: Demographic characteristics, clinical manifestations, time to diagnosis, management, and outcome.

Results: 87 patients with permanent pacemakers and 36 patients with implantable cardioverter defibrillators had infections. The most common signs and symptoms were pocket erythema and local pain. The most common pathogens were coagulase-negative staphylococci (68%) and Staphylococcus aureus (23%). In 117 patients (95%), all equipment was extracted and antibiotic therapy lasted a median of 28 days. Operative mortality was zero. Follow-up showed crude mortality and relapse rates of 8% and 3%, respectively.

Conclusion: For infections related to implantable electrophysiologic devices, complete device removal and antimicrobial therapy allow timely, successful reimplantation at a remote anatomic site without substantial risk for operative mortality or recurrent infection.

Article and Author Information

Acknowledgments: The authors thank Thomas Keys, MD; Eric Topol, MD; Patrick Vargo, BS; Dianna Bash, RN; Barbara Kirkley, MT; and Beverly Foxhall, RN.
Requests for Single Reprints: Bruce L. Wilkoff, MD, Cleveland Clinic Foundation, 9500 Euclid Avenue, F-15, Cleveland, OH 44195.
Current Author Addresses: Drs. Dy Chua, Longworth, and Gordon: Department of Infectious Disease, S32, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195.
Drs. Wilkoff and Juratli: Department of Cardiology, F-15, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195.
Dr. Lee: Department of Internal Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195.
Author Contributions: Conception and design: J. Dy Chua, B.L. Wilkoff, S.M. Gordon.
Analysis and interpretation of the data: J. Dy Chua, B.L. Wilkoff, N. Juratli, D.L. Longworth, S.M. Gordon.
Drafting of the article: J. Dy Chua, B.L. Wilkoff, N. Juratli, D.L. Longworth, S.M. Gordon.
Critical revision of the article for important intellectual content: J. Dy Chua, B.L. Wilkoff, D.L. Longworth, S.M. Gordon.
Final approval of the article: J. Dy Chua, B.L. Wilkoff, D.L. Longworth, S.M. Gordon.
Provision of study materials or patients: B.L. Wilkoff, N. Juratli.
Statistical expertise: B.L. Wilkoff.
Administrative, technical, or logistic support: J. Dy Chua, B.L. Wilkoff, D.L. Longworth.
Collection and assembly of data: J. Dy Chua, I. Lee, N. Juratli.