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CLINICAL RESEARCH: HEART RHYTHM DISORDERS

Management and Outcome of Permanent Pacemaker and Implantable Cardioverter-Defibrillator Infections

Muhammad R. Sohail, MD^_*,_*, Daniel Z. Uslan, MD^_*, Akbar H. Khan, MD, 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
Division of Cardiovascular Diseases
Department of Medicine
Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota. Dr. Sohail is currently at Tawam Hospital/Johns Hopkins Medicine, Al Ain, United Arab Emirates; Dr. Khan is currently at Emory University School of Medicine, Atlanta, Georgia; and Dr. Uslan is currently at David Geffen School of Medicine, University of California at Los Angeles, California.

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

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