Related Experiment Videos
[Infections secondary to implantation of cardiac pacemakers]
A Da Costa1, G Kirkorian, P Chevalier
1Service de cardiologie, hôpital cardiovasculaire et pneumologique Louis-Pradel, BP Lyon-Montchat, Lyon.
Abstract:
Infectious complications of pacemaker implantation are not common but may be particularly severe. Localised wound infections at the site of implantation have been reported in 0.5% of cases in the most recent series with an average of about 2%. The incidence of septicaemia and infectious endocarditis is lower, about 0.5% of cases. The operator's experience, the duration of the procedure and repeat procedures are considered to be predisposing factors. The main cause of these infections is though to be local contamination during the implantation. The commonest causal organism is the staphylococcus (75 to 92%), the staphylococcus aureus being the cause of acute infections whereas the staphylococcus epidermis is associated with cases of secondary infection. The usual clinical presentation is infection at the site of the pacemaker but other forms such as abscess, endocarditis, rejection of the implanted material, septic emboli and septic phlebitis have been described. The diagnosis is confirmed by local and systemic biological investigations and by echocardiography (especially transoesophageal echocardiography) in cases of right heart endocarditis. There are two axes of treatment: bactericidal double antibiotherapy and surgical ablation of the infected material either percutaneously or by cardiotomy. Though controversial, and unsupported by scientific evidence, the role of systematic, preoperative, prophylactic antibiotic therapy in the prevention of these complications seems to be increasing.
Insights
Pacemaker implantation infections are rare but severe, often caused by staphylococcus. Treatment involves antibiotics and surgical removal of infected material, with increasing use of prophylactic antibiotics.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Devices
Background:
- Infectious complications following pacemaker implantation, though uncommon, can be severe.
- Reported incidence rates for localized wound infections range from 0.5% to 2%, with septicaemia and infectious endocarditis occurring in approximately 0.5% of cases.
Purpose of the Study:
- To review the epidemiology, clinical presentation, diagnosis, and management of infectious complications associated with pacemaker implantation.
- To discuss predisposing factors and common causative organisms.
Main Methods:
- Literature review of infectious complications related to pacemaker implantation.
- Analysis of reported incidence rates, predisposing factors, and diagnostic modalities.
- Evaluation of current treatment strategies, including antibiotic therapy and surgical intervention.
Main Results:
- Staphylococcus is the predominant causative organism (75-92%), with Staphylococcus aureus causing acute infections and Staphylococcus epidermidis linked to secondary infections.
- Clinical presentations vary, including wound infections, abscesses, endocarditis, and septic phlebitis.
- Diagnosis relies on clinical evaluation, biological investigations, and echocardiography, particularly transoesophageal echocardiography for right heart endocarditis.
Conclusions:
- Infectious complications require a dual approach of antibiotic therapy and surgical removal of infected material.
- While evidence is limited, the use of preoperative prophylactic antibiotics is increasingly considered.
- Operator experience, procedure duration, and repeat procedures are identified as predisposing factors.