[Management of infected transvenous permanent pacemakers]

Between November, 1980, and January 1991, a total of 115 transvenous pacemakers were implanted in 102 patients at our hospital. Infection at the site of implantation developed in three cases or 2.6%. The median time of the onset of infection postoperatively was eleven and a half months, the range being two and a half to twenty-four months. Coagulase positive Staphylococcus aureus was cultured from the infected site of one patient and coagulase negative Staphylococcus epidermidis and saprophyticus in two patients. Staphylococcus aureus septicemia developed in one patient. Conservative medical treatment consisting of the application of two or more antibiotics was unsuccessful in all three cases. In two patients, removal of the infected pacemaker generator and implantation of a completely new pacemaker system at a new, clean site were conducted. In one of these two patients, the septic pacemaker electrode was withdrawn 3 months after removal of the infected pacemaker generator. In the other patient, limited thoracotomy with incision of the left brachiocephalic vein was performed for removal of the electrode three weeks after removal of the infected pacemaker generator.