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[Secondary infections after pacemaker implantation]
A Da Costa1, G Kirkorian, K Isaaz
1Service de cardiologie, hôpital Nord, CHRU, Saint-Etienne, France.
Introduction:
Infectious complications following pacemaker implantation are not common but may be particularly severe. Localized wound infections at the site of implantation have been reported in 0.5% of the cases in the most recent series, with an average of about 2%. The incidence of septicemia and infectious endocarditis is lower, about 0.5% of the cases. The operator's experience, the duration of the procedure and repeat procedures are considered to be predisposing factors.
Current Knowledge And Key Points:
The main cause of these infections has been recently demonstrated to be local contamination during implantation. The commonest causal organism is Staphylococcus (75 to 92% of the cases), Staphylococcus aureus being the cause of acute infections (less than 6 weeks), whereas Staphylococcus epidermidis is associated with cases of secondary infection (more than 2 months). The usual clinical presentation is infection at the site of the pacemaker but other forms such as abscess, endocarditis, rejection of the implanted material, septic emboli or phlebitis have been described. The diagnosis is confirmed by local and systemic biological investigations and by echocardiography (especially transesophageal echocardiography) in cases of right heart endocarditis. There are two axes of treatment: bactericidal double antibiotherapy and surgical ablation of the infected material either percutaneously or by cardiotomy.
Future Prospects And Projects:
A recent meta-analysis supported the role of systematic, preoperative, prophylactic antibiotic therapy in the prevention of these complications. These data should be confirmed by suitably powered clinical trials.
Insights
Preventing pacemaker implantation infections is crucial. Prophylactic antibiotics before surgery may reduce complications, but further clinical trials are needed to confirm their effectiveness.
Area of Science:
- Cardiovascular medicine
- Infectious diseases
- Surgical outcomes
Context:
- Infectious complications after pacemaker implantation, though uncommon, can be severe.
- Localized infections occur in 0.5-2% of cases, with septicemia and endocarditis being less frequent.
- Risk factors include operator experience, procedure duration, and repeat procedures.
Purpose:
- To review the causes, diagnosis, and treatment of pacemaker implantation infections.
- To evaluate the role of prophylactic antibiotic therapy in preventing these complications.
Summary:
- Infections are primarily caused by local contamination during implantation, with Staphylococcus species being the most common pathogens.
- Diagnosis involves clinical evaluation, biological investigations, and echocardiography for suspected endocarditis.
- Treatment combines antibiotic therapy with surgical removal of infected material.
Impact:
- Preoperative prophylactic antibiotics show promise in preventing pacemaker infections, as suggested by meta-analysis.
- Further large-scale clinical trials are necessary to validate these findings and establish definitive guidelines.