Infections associated with permanent pacemakers and implanted cardioverter–defibrillator devices. A 10-year regional study in Denmark

Abstract

Endocarditis and localized pocket infections are recognized as serious adverse events in patients with implanted cardiac impulse generators. We have undertaken a 10-y retrospective study in North Denmark Region (population 0.5 million) in order to elucidate the clinical spectrum, causative microorganisms, management and outcome. Infections associated with permanent pacemakers (PPM) and implanted cardioverter-defibrillator (ICD) devices were identified by searching hospital databases. Ninety-one incident cases were recorded in 1999 through 2008: 26 patients had endocarditis, 39 patients had a localized pocket infection, and 9 patients developed surgical sepsis with or without local signs immediately after implantation or reoperation; the device was the likely but unconfirmed focus of infection in 17 patients with bacteraemia. Staphylococcus aureus, coagulase-negative staphylococci and other Gram-positive bacteria were the predominant causative agents; only 6 cases were culture-negative. Management included device and lead extraction and individualized antibiotic therapy. The all-cause 30-day case-fatality was 11%. Only 3 recurrences were recorded during 2 y of follow-up. In conclusion, infections associated with permanent impulse generators have a broader clinical spectrum than often reported in the literature. Most cases are culture-positive with staphylococcal predominance. The short-term mortality is notably high, but the risk of recurrence is low.

Acknowledgements

We are indebted to Tove Højbjerg for valuable discussions and to Inge Marie Borup for assisting us with the retrieval of patient information. Jesper Smit has received a 3-month scholarship from Aalborg Hospital, Aarhus University Hospital.

Declaration of interest: The authors have no conflicts of interest connected to this study.