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Septicaemia in patients with temporary and permanent endocardial pacemakers
1Department of Medical Microbiology, St George's Hospital Medical School, London.
Abstract:
Twenty-four patients with staphylococcal septicaemia due to permanent (14) and temporary (10) endocardial pacemakers were reviewed. With permanent pacemakers local inflammation was usually present and the onset of septicaemia rapid. If patients were treated with high dose intravenous flucloxacillin combined with removal, recovery was usual. In patients with retained endocardial tips (6) we eradicated infection with medical treatment alone in four cases. We would advocate antistaphylococcal prophylaxis for patients undergoing revision in the presence of local inflammation and high dose intravenous flucloxacillin plus a second anti-staphylococcal antibiotic (e.g. gentamicin) in patients with septicaemia and a pacemaker in situ.
Insights
Staphylococcal septicaemia in pacemaker patients often requires high-dose flucloxacillin and device removal for recovery. Medical treatment alone can eradicate infection in some cases with retained pacemaker tips.
Area of Science:
- Infectious Diseases
- Cardiology
- Medical Device Infections
Background:
- Staphylococcal septicaemia is a serious complication in patients with endocardial pacemakers.
- Distinguishing between permanent and temporary pacemaker-related infections is crucial for treatment strategies.
Observation:
- Twenty-four patients with staphylococcal septicaemia associated with permanent (14) and temporary (10) pacemakers were analyzed.
- Permanent pacemaker infections often presented with rapid onset septicaemia and local inflammation.
- A subset of patients (6) had retained endocardial pacemaker tips.
Findings:
- High-dose intravenous flucloxacillin combined with pacemaker removal led to usual recovery.
- Four out of six patients with retained endocardial tips achieved infection eradication with medical treatment alone.
- Antistaphylococcal prophylaxis is recommended for pacemaker revisions with local inflammation.
Implications:
- Aggressive antibiotic therapy, including high-dose flucloxacillin and potentially a second agent like gentamicin, is vital for pacemaker-related septicaemia.
- The management strategy should consider the type of pacemaker and presence of retained material.
- Prophylactic measures can mitigate infection risk during pacemaker procedures in inflamed environments.