Sustained bacteremia and transvenous cardiac pacemakers

Five patients with transvenous cardiac pacemakers had sustained staphylococcal bacteremia (defined as bacteremia for at least 12 hours) two weeks to ten months after pacemaker insertion. Three of the five patients had no evidence of an extravascular focus of infection at the time of stphylococcal bacteremia. An additional patient had a petechial rash, which is unusual in staphylococcal bacteremia, unless endocarditis is present. All patients were treated with antibiotics and drainage of the pacemaker packet when it was infected, removal of the pacemaker generator, or removal of the catheter electrode. One patient without evidence of pocket infection was treated successfully with antibiotic therapy alone.