CLINICAL RESEARCH: HEART RHYTHM DISORDER
Management and Outcome of Permanent Pacemaker and Implantable Cardioverter-Defibrillator Infections
Muhammad R. Sohail, MD*,*,1,
Daniel Z. Uslan, MD*,3,
Akbar H. Khan, MD ,2,
Paul A. Friedman, MD ,
David L. Hayes, MD,
Walter R. Wilson, MD*,
James M. Steckelberg, MD*,
Sarah Stoner, MS and
Larry M. Baddour, MD*
* Division of Infectious Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota.
Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota.
Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota.
Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota.
Manuscript received October 2, 2006;
revised manuscript received December 11, 2006,
accepted January 2, 2007.
* Reprint requests and correspondence: Dr. Muhammad R. Sohail, Department of Medicine, Division of Infectious Diseases, Tawam Hospital/Johns Hopkins Medicine, P.O. Box 15258, Al Ain, Abu Dhabi, United Arab Emirates. (Email: msohail{at}tawam-hosp.gov.ae).
Data presented in part at the 43rd Annual Meeting of the Infectious Diseases Society of America, October 6 to 9, 2005, San Francisco, California (abstract no. 387).
Objectives: We describe the management and outcome of permanent pacemaker (PPM) and implantable cardioverter-defibrillator (ICD) infections in a large cohort of patients seen at a tertiary care facility with expertise in device lead extraction.
Background: Infection is a serious complication of PPM and ICD implantation. Optimal care of patients with these cardiac device infections (CDI) is not well defined.
Methods: A retrospective review of all patients with CDI admitted to Mayo Clinic Rochester between January 1, 1991, and December 31, 2003, was conducted. Demographic and clinical data were collected, and descriptive analysis was performed.
Results: A total of 189 patients met the criteria for CDI (138 PPM, 51 ICD). The median age of the patients was 71.2 years. Generator pocket infection (69%) and device-related endocarditis (23%) were the most common clinical presentations. Coagulase-negative staphylococci and Staphylococcus aureus, in 42% and 29% of cases, respectively, were the leading pathogens for CDI. Most patients (98%) underwent complete device removal. Duration of antibiotic therapy after device removal was based on clinical presentation and causative organism (median duration of 18 days for pocket infection vs. 28 days for endocarditis; 28 days for S. aureus infection vs. 14 days for coagulase-negative staphylococci infection [p < 0.001]). Median follow-up after hospital discharge was 175 days. Ninety-six percent of patients were cured with both complete device removal and antibiotic administration.
Conclusions: Cure of CDI is achievable in the large majority of patients treated with an aggressive approach of combined antimicrobial treatment and complete device removal. Based on findings of our large retrospective institutional survey and previously published data, we submit proposed management guidelines of CDI.
|
Abbreviations and Acronyms
| | BSI = blood stream infection | | CDI = cardiac device infection | | CoNS = coagulase-negative staphylococci | | ICD = implantable cardioverter-defibrillator | | PPM = permanent pacemaker |
|
This article has been cited by other articles:
|
|
|
|
 
A. J. Greenspon, J. M. Prutkin, M. R. Sohail, H. R. Vikram, L. M. Baddour, S. B. Danik, J. Peacock, C. Falces, J. M. Miro, E. Blank, et al.
Timing of the Most Recent Device Procedure Influences the Clinical Outcome of Lead-Associated Endocarditis: Results of the MEDIC (Multicenter Electrophysiologic Device Infection Cohort)
J. Am. Coll. Cardiol.,
February 14, 2012;
59(7):
681 - 687.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Durante-Mangoni, R. Casillo, M. Bernardo, C. Caianiello, I. Mattucci, D. Pinto, F. Agrusta, R. Caprioli, R. Albisinni, E. Ragone, et al.
High-Dose Daptomycin for Cardiac Implantable Electronic Device-Related Infective Endocarditis
Clinical Infectious Diseases,
February 1, 2012;
54(3):
347 - 354.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. Lebeaux, F. Barbier, C. Angebault, L. Benmahdi, E. Ruppe, B. Felix, K. Gaillard, F. Djossou, L. Epelboin, C. Dupont, et al.
Evolution of Nasal Carriage of Methicillin-Resistant Coagulase-Negative Staphylococci in a Remote Population
Antimicrob. Agents Chemother.,
January 1, 2012;
56(1):
315 - 323.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Authors (EHRA Task Force Members), J. C. Deharo, M. G. Bongiorni, A. Rozkovec, F. Bracke, P. Defaye, I. Fernandez-Lozano, P. G. Golzio, B. Hansky, C. Kennergren, et al.
Pathways for training and accreditation for transvenous lead extraction: a European Heart Rhythm Association position paper
Europace,
January 1, 2012;
14(1):
124 - 134.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Pichlmaier, L. Knigina, I. Kutschka, C. Bara, H. Oswald, G. Klein, T. Bisdas, and A. Haverich
Complete removal as a routine treatment for any cardiovascular implantable electronic device-associated infection
J. Thorac. Cardiovasc. Surg.,
December 1, 2011;
142(6):
1482 - 1490.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. R. Sohail, C. A. Henrikson, M. J. Braid-Forbes, K. F. Forbes, and D. J. Lerner
Mortality and Cost Associated With Cardiovascular Implantable Electronic Device Infections
Arch Intern Med,
November 14, 2011;
171(20):
1821 - 1828.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Zucchelli, M. G. Bongiorni, A. Di Cori, E. Soldati, G. Solarino, I. Fabiani, L. Segreti, R. De Lucia, S. Viani, G. Coluccia, et al.
Cardiac resynchronization therapy after coronary sinus lead extraction: feasibility and mid-term outcome of transvenous reimplantation in a tertiary referral centre
Europace,
October 28, 2011;
(2011)
eur339v1.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. J. Greenspon, J. D. Patel, E. Lau, J. A. Ochoa, D. R. Frisch, R. T. Ho, B. B. Pavri, and S. M. Kurtz
16-Year Trends in the Infection Burden for Pacemakers and Implantable Cardioverter-Defibrillators in the United States: 1993 to 2008
J. Am. Coll. Cardiol.,
August 30, 2011;
58(10):
1001 - 1006.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. S. DABABNEH and M. R. SOHAIL
Cardiovascular implantable electronic device infection: A stepwise approach to diagnosis and management
Cleveland Clinic Journal of Medicine,
August 1, 2011;
78(8):
529 - 537.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Rossi, F. Pirone, S. Nair, and U. Trivedi
Massive Acute Aortic Regurgitation After Infected Pacemaker Lead Removal: A Word of Caution
Ann. Thorac. Surg.,
August 1, 2011;
92(2):
e29 - e31.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Landolina, M. Gasparini, M. Lunati, S. Iacopino, G. Boriani, C. Bonanno, A. Vado, A. Proclemer, A. Capucci, C. Zucchiatti, et al.
Long-Term Complications Related to Biventricular Defibrillator Implantation: Rate of Surgical Revisions and Impact on Survival: Insights From the Italian ClinicalService Database
Circulation,
June 7, 2011;
123(22):
2526 - 2535.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. M. Baddour, A. E. Epstein, C. C. Erickson, B. P. Knight, M. E. Levison, P. B. Lockhart, F. A. Masoudi, E. J. Okum, W. R. Wilson, L. B. Beerman, et al.
A Summary of the Update on Cardiovascular Implantable Electronic Device Infections and Their Management: A Scientific Statement From the American Heart Association
J Am Dent Assoc,
February 1, 2011;
142(2):
159 - 165.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Bechara, M. Gousseff, A. Passeron, I. Podglajen, N. Day, J. Pouchot, T. Lavergne, and J.- L. Mainardi
Corynebacterium jeikeium pacemaker infection associated with antineutrophil cytoplasmic antibodies: a single positive blood culture could be sufficient for diagnosis
J. Med. Microbiol.,
February 1, 2011;
60(2):
249 - 251.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Madhavan, M. R. Sohail, P. A. Friedman, D. L. Hayes, J. M. Steckelberg, W. R. Wilson, L. M. Baddour, and for the Mayo Cardiovascular Infections Study Group
Outcomes in Patients With Cardiovascular Implantable Electronic Devices and Bacteremia Caused by Gram-Positive Cocci Other Than Staphylococcus Aureus
Circ Arrhythm Electrophysiol,
December 1, 2010;
3(6):
639 - 645.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Oliva, V. Belvisi, M. Iannetta, C. Andreoni, M. T. Mascellino, M. Lichtner, V. Vullo, and C. M. Mastroianni
Pacemaker Lead Endocarditis Due to Multidrug-Resistant Corynebacterium striatum Detected with Sonication of the Device
J. Clin. Microbiol.,
December 1, 2010;
48(12):
4669 - 4671.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. M. Kratz and J. M. Toole
Pacemaker and Internal Cardioverter Defibrillator Lead Extraction: A Safe and Effective Surgical Approach
Ann. Thorac. Surg.,
November 1, 2010;
90(5):
1411 - 1417.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. M. Viola, L. L. Awan, and R. O. Darouiche
Nonstaphylococcal Infections of Cardiac Implantable Electronic Devices
Circulation,
May 18, 2010;
121(19):
2085 - 2091.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. M. Baddour
Cardiac Device Infection--or Not
Circulation,
April 20, 2010;
121(15):
1686 - 1687.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Kuehn, K. Graf, W. Heuer, A. Hilfiker, I. F. Chaberny, M. Stiesch, and A. Haverich
Economic implications of infections of implantable cardiac devices in a single institution
Eur J Cardiothorac Surg,
April 1, 2010;
37(4):
875 - 879.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. A. Grammes, C. M. Schulze, M. Al-Bataineh, G. A. Yesenosky, C. S. Saari, M. J. Vrabel, J. Horrow, M. Chowdhury, J. M. Fontaine, and S. P. Kutalek
Percutaneous Pacemaker and Implantable Cardioverter-Defibrillator Lead Extraction in 100 Patients With Intracardiac Vegetations Defined by Transesophageal Echocardiogram
J. Am. Coll. Cardiol.,
March 2, 2010;
55(9):
886 - 894.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Habib, (France), L. Badano, (Italy), C. Tribouilloy, (France), I. Vilacosta, (Spain), J. L. Zamorano, (Spain), et al.
Recommendations for the practice of echocardiography in infective endocarditis
Eur Heart J Cardiovasc Imaging,
March 1, 2010;
11(2):
202 - 219.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
O. Wazni, L. M. Epstein, R. G. Carrillo, C. Love, S. W. Adler, D. W. Riggio, S. S. Karim, J. Bashir, A. J. Greenspon, J. P. DiMarco, et al.
Lead Extraction in the Contemporary Setting: The LExICon Study: An Observational Retrospective Study of Consecutive Laser Lead Extractions
J. Am. Coll. Cardiol.,
February 9, 2010;
55(6):
579 - 586.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. M. Baddour, A. E. Epstein, C. C. Erickson, B. P. Knight, M. E. Levison, P. B. Lockhart, F. A. Masoudi, E. J. Okum, W. R. Wilson, L. B. Beerman, et al.
Update on Cardiovascular Implantable Electronic Device Infections and Their Management: A Scientific Statement From the American Heart Association
Circulation,
January 26, 2010;
121(3):
458 - 477.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Rusanov and H. M. Spotnitz
A 15-Year Experience With Permanent Pacemaker and Defibrillator Lead and Patch Extractions
Ann. Thorac. Surg.,
January 1, 2010;
89(1):
44 - 50.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Kleemann, T. Becker, M. Strauss, N. Dyck, U. Weisse, W. Saggau, U. Burkhardt, and K. Seidl
Prevalence of bacterial colonization of generator pockets in implantable cardioverter defibrillator patients without signs of infection undergoing generator replacement or lead revision
Europace,
January 1, 2010;
12(1):
58 - 63.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Margey, H. McCann, G. Blake, E. Keelan, J. Galvin, M. Lynch, N. Mahon, D. Sugrue, and J. O'Neill
Contemporary management of and outcomes from cardiac device related infections
Europace,
January 1, 2010;
12(1):
64 - 70.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. De Silva, A. Fife, F. Murgatroyd, and N. Gall
Pacemaker endocarditis: an important clinical entity
BMJ Case Reports,
November 18, 2009;
2009(nov18_1):
bcr0220091608 - bcr0220091608.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
G. M. Calvagna, R. Evola, G. Scardace, and S. Valsecchi
Single-operator experience with a mechanical approach for removal of pacing and implantable defibrillator leads
Europace,
November 1, 2009;
11(11):
1505 - 1509.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Endorsed by the European Society of Clinical Micro, Authors/Task Force Members, G. Habib, B. Hoen, P. Tornos, F. Thuny, B. Prendergast, I. Vilacosta, P. Moreillon, M. de Jesus Antunes, et al.
Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): The Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC)
Eur. Heart J.,
October 1, 2009;
30(19):
2369 - 2413.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M.J. P. Raatikainen, J. Perala, and J. Lahtinen
Successful defibrillator lead remnant extraction from right ventricle using a steerable transseptal sheath and a basket retriever
Europace,
September 1, 2009;
11(9):
1238 - 1240.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Korantzopoulos, K. P. Letsas, G. Grekas, and J. A. Goudevenos
Pacemaker dependency after implantation of electrophysiological devices
Europace,
September 1, 2009;
11(9):
1151 - 1155.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. Franceschi, F. Thuny, R. Giorgi, I. Sanaa, E. Peyrouse, X. Assouan, S. Prevot, E. Bastard, G. Habib, and J.-C. Deharo
Incidence, Risk Factors, and Outcome of Traumatic Tricuspid Regurgitation After Percutaneous Ventricular Lead Removal
J. Am. Coll. Cardiol.,
June 9, 2009;
53(23):
2168 - 2174.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J C Lekkerkerker, C van Nieuwkoop, S A Trines, J G van der Bom, A Bernards, E T van de Velde, M Bootsma, K Zeppenfeld, J W Jukema, J-W Borleffs, et al.
Risk factors and time delay associated with cardiac device infections: Leiden device registry
Heart,
May 1, 2009;
95(9):
715 - 720.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. S. Baman, S. K. Gupta, J. A. Valle, and E. Yamada
Risk Factors for Mortality in Patients With Cardiac Device-Related Infection
Circ Arrhythm Electrophysiol,
April 1, 2009;
2(2):
129 - 134.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. Schulz, K. Puschel, and E. E. Turk
Fatal complications of pacemaker and implantable cardioverter-defibrillator implantation: medical malpractice?
Interact CardioVasc Thorac Surg,
April 1, 2009;
8(4):
444 - 448.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Bis, K. Goscinska-Bis, M. Krejca, E. Zinka, J. Skarysz, L. Machej, and A. Bochenek
Surgical extraction of cardiac resynchronization therapy system with concomitant implantation of a new system with the use of epicardial leads in a patient with endocarditis
J. Thorac. Cardiovasc. Surg.,
September 1, 2008;
136(3):
786 - 787.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Pichlmaier, V. Marwitz, C. Kuhn, M. Niehaus, G. Klein, C. Bara, A. Haverich, and W.-R. Abraham
High prevalence of asymptomatic bacterial colonization of rhythm management devices
Europace,
September 1, 2008;
10(9):
1067 - 1072.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. R. Sohail, D. Z. Uslan, A. H. Khan, P. A. Friedman, D. L. Hayes, W. R. Wilson, J. M. Steckelberg, S. M. Stoner, and L. M. Baddour
Risk Factor Analysis of Permanent Pacemaker Infection
Clinical Infectious Diseases,
July 15, 2007;
45(2):
166 - 173.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
