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Similar intraoperative microbiomes in de novo and replacement cardiac implantable electronic device pockets support

Zhe Xu1,2,3,4,5, Xuehai Chen1,2,3,4,5, Kezeng Gong1,2,3,4,5

  • 1Department of Cardiology, Fujian Medical University Union Hospital, Fuzhou, China.

Frontiers in Cellular and Infection Microbiology
|July 28, 2026
PubMed
Abstract

Insights

Bacteria in cardiac implantable electronic device pockets likely stem from intraoperative contamination, not colonization. Rigorous aseptic technique is crucial for preventing device infections.

Area of Science:

  • Microbiology
  • Medical Devices
  • Infectious Disease Prevention

Background:

  • The origin of bacteria in cardiac implantable electronic device (CIED) pockets is critical for effective infection prevention.
  • Distinguishing between true colonization and intraoperative contamination guides strategy.

Purpose of the Study:

  • To compare intraoperative microbial dynamics during new pacemaker implantation versus generator replacement.
  • Utilize 16S rRNA gene sequencing to analyze microbial communities in CIED pockets.

Main Methods:

  • Prospective study of 18 asymptomatic patients (11 new implants, 7 replacements).
  • Collected samples from skin (T1), pocket post-creation (T2), and pocket pre-closure (T3).
  • Performed 16S rRNA gene sequencing (V3-V4 region) and diversity analyses (alpha and beta).

Main Results:

  • Microbial composition and abundance were similar between new and replacement CIED groups at all timepoints.
  • No significant differences in alpha or beta diversity were observed in pockets (T2, T3) between groups.
  • New implantations showed higher skin alpha diversity (T1), possibly due to age-related skin flora.

Conclusions:

  • Prevalence of environmental bacteria and lack of distinct signatures in replacement pockets suggest intraoperative contamination.
  • Emphasizes the critical role of stringent aseptic technique in preventing CIED infections.
  • Suggests focusing on contamination prevention rather than colonization surveillance.
Keywords:
16S rRNA sequencingaseptic techniquecontaminationhealthcare-associated infectionpacemakersurgical site infection

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