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Frequency of permanent pacemaker or implantable cardioverter-defibrillator infection in patients with gram-negative
Daniel Z Uslan1, Muhammad R Sohail, Paul A Friedman
1Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905, USA. uslan.daniel@mayo.edu
Background:
Despite the frequent occurrence of bacteremia due to gram-negative organisms in patients with underlying permanent pacemakers (PPMs) or implantable cardioverter defibrillators (ICDs), the outcome and treatment of these patients has received scant attention. In patients with PPMs or ICDs who have Staphylococcus aureus bacteremia, 45% have PPM/ICD infection.
Methods:
We conducted a retrospective cohort study over a 7-year period to assess the clinical features and frequency of PPM/ICD infection in patients with gram-negative bacteremia, as well as the incidence of relapse in patients for whom the device was not removed.
Results:
Forty-nine patients were included in the study; 3 (6%) had either definite (2 patients) or possible (1 patient) PPM/ICD infection. Both patients with definite PPM/ICD infection had clear infection of the generator pocket. None of the other patients with alternate sources of bacteremia developed PPM/ICD infection. Thirty-four patients with retained PPM/ICD were observed for >12 weeks (median time, 759 days), and 2 (6%) developed relapsing bacteremia, although they each had alternative sources of relapse.
Conclusions:
In sharp contrast to S. aureus infection, PPM/ICD infection in patients with gram-negative bacteremia was rare, and no patients appeared to have secondary PPM/ICD infection due to hematogenous seeding of the system. Despite infrequent system removal in these patients, relapsing bacteremia among patients who survived initial bacteremia was rarely seen. If secondary PPM/ICD infection occurs in patients with gram-negative bacteremia, it is either uncommon or it is cured with antimicrobial therapy despite device retention.
Insights
Gram-negative bacteremia rarely leads to permanent pacemaker (PPM) or implantable cardioverter defibrillator (ICD) infection. Relapsing bacteremia is also uncommon in patients with retained devices, suggesting antimicrobial therapy may suffice.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Devices
Background:
- Gram-negative bacteremia is common in patients with permanent pacemakers (PPMs) or implantable cardioverter defibrillators (ICDs).
- Staphylococcus aureus bacteremia in these patients leads to PPM/ICD infection in 45% of cases.
- Little attention has been paid to the outcomes of gram-negative bacteremia in PPM/ICD patients.
Purpose of the Study:
- To assess the clinical features and frequency of PPM/ICD infection in patients with gram-negative bacteremia.
- To determine the incidence of relapsing bacteremia in patients who retained their devices.
Main Methods:
- Retrospective cohort study over a 7-year period.
- Inclusion of 49 patients with gram-negative bacteremia and PPMs/ICDs.
- Assessment of PPM/ICD infection and bacteremia relapse in patients with retained devices.
Main Results:
- Only 3 (6%) patients had definite or possible PPM/ICD infection, primarily in the generator pocket.
- No PPM/ICD infections were observed in patients with alternative bacteremia sources.
- Two patients (6%) with retained devices developed relapsing bacteremia, but with alternative sources.
Conclusions:
- PPM/ICD infection is rare in gram-negative bacteremia, unlike S. aureus infections.
- Secondary PPM/ICD infection from hematogenous seeding appears uncommon.
- Relapsing bacteremia is rare in survivors, and antimicrobial therapy may be effective despite device retention.
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