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Published on: February 17, 2015
Risk Factor for Cardiac Permanent Pacemaker Infection
Hammad Shah1, Mazhar Mehmood1, Momin Salahudin1
1Cardiology Department, Rehman Medical Institute Peshawar, Sector 2/B, Phase 5, Hayatabad Peshawar, Pakistan.
Background:
Cardiac pacemaker infections have increased globally due to increase in demand and lack of adequate knowledge about its significantly contributing risk factors. This study was therefore aimed to determine the prevailing causative microbes and risk factors of both single and dual chamber permanent pacemaker infections.
Methods:
This was a retrospective case control study. Cases were selected as culture positive swab, Temporary pacemaker wire or catheter were matched with three controls for each variable using chi square test. Multivariate regression analysis was done to determine risk factors.
Results:
Among 47 cases, 23.4% cases were infected by methicillin resistant staph aureus, 14.9% by methicilin susceptible Staphylococcus aureus, 10.6% by pseudomonas, 8.5% by escherichia coli and 6.4% by klebsiella. Temporary pacemaker/Central line placed >24 hours ago before permanent pacemaker implantation, remnant pacemaker leads, corticosteroid use, no antibiotic prophylaxis, diabetes, smoking and non-absorbable stitches had statistically significant association with permanent pacemaker infection using multivariate regression model analysis. Chronic obstructive pulmonary disease and non-absorbable stitches had a non-significant association.
Conclusions:
Temporary pacemaker/Central line placed >24hours before permanent pacemaker implantation, remnant pacemaker leads, corticosteroid use, no antibiotic prophylaxis, diabetes, smoking and use of non-absorbable stitches are risk factors for permanent pacemaker infection. Staph aureus is the most prevalent microorganism causing infection.
Insights
Permanent pacemaker infections are rising, with Staphylococcus aureus being the most common cause. Key risk factors include prolonged temporary lines, retained leads, corticosteroid use, and diabetes.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Microbiology
Background:
- Global increase in cardiac pacemaker infections noted.
- Inadequate knowledge of contributing risk factors identified as a concern.
- Need to identify prevalent microbes and risk factors for pacemaker infections.
Purpose of the Study:
- Determine prevailing causative microbes of permanent pacemaker infections.
- Identify significant risk factors for single and dual chamber permanent pacemaker infections.
Main Methods:
- Retrospective case-control study design.
- Culture-positive cases matched with three controls.
- Multivariate regression analysis employed to identify risk factors.
Main Results:
- Staphylococcus aureus (MRSA and MSSA) identified as the most frequent pathogens.
- Significant risk factors identified: prolonged temporary pacemaker/central line use (>24h), remnant pacemaker leads, corticosteroid use, lack of antibiotic prophylaxis, diabetes, smoking, and non-absorbable sutures.
- COPD and non-absorbable sutures showed non-significant association.
Conclusions:
- Identified modifiable and non-modifiable risk factors for permanent pacemaker infections.
- Staphylococcus aureus is the predominant causative agent.
- Findings emphasize the importance of managing identified risk factors to prevent infections.
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