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Septicaemia and endocarditis--uncommon but serious complications in connection with permanent cardiac pacing
Abstract:
Between 1971 and 1978 septicaemia was observed in 14 patients undergoing permanent pacemaker treatment. The causative microorganisms were: S. aureus (9), S. epidermidis (3), alfa-haemolytic streptococci + P. morganii (1), enterococci (1). In 4 patients, a mural endocarditis of the right atrial wall surrounding the electrode was found at operation or autopsy. The interval between the preceding pacemaker operation and onset of septicaemia varied between 2 days and 23 months (median 2 months). In 5 patients, the last operation before septicaemia was performed because of local infection in the pacemaker pocket or along the electrode. A probable portal of entry was found in 11 patients. The electrode was the origin in 8, the pacemaker pocket in one, and a focus outside the pacemaker system in 2. Of the 6 patients treated with antibiotics alone, 3 were cured, 2 died and one is still on treatment. Eight patients underwent various surgical procedures in addition to the antibiotic treatment. In 4 the electrode was completely removed. In 2 of them cardiotomy during extracorporeal circulation had to be used. All of these patients were cured. In 3 the pacemaker system was partially extracted. Only one of them was cured, one developed osteomyelitis and one died. Based on our experience, we now recommend that all foreign material should be removed, if possible, in the presence of septicaemia and/or endocarditis, and that parenteral antibiotic treatment should be given for at least 6 weeks.
Insights
Septicemia in pacemaker patients, often caused by Staphylococcus aureus, requires prompt removal of foreign materials like electrodes. Complete removal combined with antibiotics offers the best cure rates for pacemaker infections and endocarditis.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Device Infections
Background:
- Septicemia is a serious complication in patients with permanent pacemaker devices.
- Infections can arise from the pacemaker pocket, electrode, or external sources.
- Common causative microorganisms include Staphylococcus aureus and Staphylococcus epidermidis.
Purpose of the Study:
- To analyze the incidence, causative agents, and outcomes of septicemia in pacemaker patients.
- To evaluate the effectiveness of different treatment strategies, including antibiotics and surgical intervention.
- To provide recommendations for managing pacemaker-related infections and endocarditis.
Main Methods:
- Retrospective analysis of 14 patients with permanent pacemaker treatment who developed septicemia between 1971 and 1978.
- Identification of causative microorganisms and assessment of infection sources (electrode, pocket, external).
- Review of treatment outcomes based on antibiotic therapy alone versus combined surgical and antibiotic approaches.
Main Results:
- Staphylococcus aureus was the most frequent pathogen (9/14 patients).
- Mural endocarditis was observed in 4 patients.
- Complete removal of the infected pacemaker electrode and foreign material, coupled with antibiotics, resulted in a 100% cure rate.
Conclusions:
- Septicemia and endocarditis in pacemaker patients necessitate the removal of all foreign materials whenever feasible.
- A minimum of 6 weeks of parenteral antibiotic treatment is recommended.
- Aggressive surgical management combined with antibiotics is crucial for successful outcomes.