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Updated: Aug 18, 2026
Multiplex Detection of Bacteria in Complex Clinical and Environmental Samples using Oligonucleotide-coupled Fluorescent Microspheres
Published on: October 23, 2011
Detailed bacteriologic tests to identify the origin of transvenous pacing system infections indicate a high
Didier Klug1, Frédéric Wallet, Salem Kacet
1Department of Cardiology, University of Lille, Lille, France. dklug@chru-lille.fr
Background:
The reported incidence of pacing system-related infections (PSIs) varies widely, and the roles of leads and blood cultures remain poorly defined.
Methods:
Leads and blood cultures were obtained prospectively in 224 patients with suspected PSIs, and the results of cultures of blood and extravascular and intravascular lead fragments were compared.
Results:
In 12.3% of the patients, no microorganism was found on the leads. Lead cultures with > or =1 microorganism cultured on the extravascular and intravascular fragments of the leads were found in 88.5% of the positive lead cultures. Infection was caused by Staphylococcus epidermidis and coagulase-negative staphylococci in 66.0% and 29.5%, respectively. Only 33 patients had positive blood cultures according to the Duke criteria with the same microorganism found by lead cultures in 30 cases. Infection was caused by multiple organisms in 39 (25%) patients.
Conclusion:
(1) Regardless of the clinical presentation, the extravascular and intravascular body of the lead is infected, even when the infection is local. More than one microorganism may be implicated. (2) Bacteriologic analyses must be performed on several segments of each implanted lead. (3) More than 2 positive blood cultures are a reliable clinical criterion for the diagnosis of pacemaker lead-related infection, but blood cultures alone are an insensitive method to identify the cause of infection. (4) Up to 50% of microorganisms isolated in a single blood culture are also recovered in lead cultures.
Insights
Pacing system-related infections (PSIs) often involve lead contamination, even with negative blood cultures. Analyzing lead fragments is crucial for accurate diagnosis and identifying multiple microorganisms in these infections.
Area of Science:
- Infectious Diseases
- Cardiology
- Microbiology
Background:
- Pacing system-related infections (PSIs) have a widely reported incidence, with unclear roles for leads and blood cultures.
- Accurate diagnosis of PSIs is challenging due to variable clinical presentations and diagnostic criteria.
Purpose of the Study:
- To compare the diagnostic yield of lead cultures versus blood cultures in patients with suspected PSIs.
- To determine the microorganisms involved in pacing system infections and their distribution on leads.
Main Methods:
- Prospective collection of leads and blood cultures from 224 patients with suspected PSIs.
- Culturing of extravascular and intravascular lead fragments alongside blood cultures.
- Comparison of microbial findings from lead cultures and blood cultures using Duke criteria.
Main Results:
- Microorganisms were detected on lead fragments in 88.5% of positive lead cultures.
- Staphylococcus epidermidis (66.0%) and coagulase-negative staphylococci (29.5%) were the most common pathogens.
- Only 33 patients had positive blood cultures, with 30 matching lead culture results; 25% of infections involved multiple organisms.
Conclusions:
- Pacing system leads are frequently infected, even in localized infections, often by multiple microorganisms.
- Bacteriological analysis of multiple lead segments is essential for accurate diagnosis.
- While multiple positive blood cultures can indicate infection, they are insensitive for identifying the causative agents; lead cultures are more reliable.
