96-51: Pacemaker and ICD device related infections - Diagnosis and treatment of a serious problem - A growing challenge

Abstract

Introduction: With the increasing number of device implantations in patients with high comorbidity the number of device-related infections has been growing in the last few years. The device related Infection is a serious and life threatening complication after pacemaker and ICD implantation. Both the diagnosis and optimal treatment of such infections are a big challenge for the clinical everyday life. Methods: We examined retrospectively 107 consecutive patients (ø)69.1 years, 22 ♀, 85 ♂) who were referred to us with a device-related infection treated between January 2004 and September 2008. The diagnosis was made either by pocket erythema, erosion, abscess, persistent bacteremia and/or positive blood cultures or endocarditis with or without vegetation on the lead. Result: Of 107 patients with proven device-related infection, 84 patients had a pacemaker, 22 patients an ICD (5 biventricular systems) and 1 patient had an OPTIMIZER. 65 of these patients (70%) underwent a prior replacement. The average delay after replacement was 12 months. The bacteriologic organism (blood culture, purulent material from the pocket) was identified in 67% of our patients. The organisms were Staphylococci aureus in 26 patients, coagulase negative Staphylococci (e.g. Staphylococci epidermidis) in 21 patients, 4 patients with MRSA, Enterococci (6 patients), Streptococci (4 patients), 1 patient with Serratia marcescens, and 1 patient with Pseudomonas. Valvular or lead vegetations were detected by echocardiography in 34 of these patients. An interventional explantation succeeded in 88 patients. Only 19 patients had to be explanted by cardiac surgeons mainly due to the need of an epicardial pacemaker. Summary Device replacement or upgrade surgeries are associated with a high infection rate. Staphlococci is the most common organism causing a device-related infection. The bacteriologic organism is only identified in two-thirds of device-related infections. A complex strategy has to be chosen including clinical status (pocket inspection), blood samples, and transesophageal echocardiography to differentiate between vegetations, thrombi or scar tissue to identify an infection in order to avoid a risky device and lead explantation.