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Permanent Pacemaker and Implantable Cardioverter Defibrillator Infection

2007/04/09 by Daniel Z. Uslan, Muhammad R Sohail, Jennifer L St Sauver +6 · 28 citations
Arts and Humanities · Health Professions · #Hermeneutics and Narrative Identity #Aging, Elder Care, and Social Issues #Health, Medicine and Society

paper · doi:10.1001/archinte.167.7.669

Abstract

<h3>Background</h3> The incidence of cardiac device infection is not well understood. Bloodstream infection (BSI) in patients with permanent pacemakers or implantable cardioverter-defibrillators (hereafter, defibrillators) may reflect device infection. <h3>Methods</h3> Retrospective, population-based cohort study of all adult patients with cardiac devices who resided in Olmsted County, Minnesota, from 1975 to 2004. The medical linkage-system of the Rochester Epidemiology Project and standardized criteria were used to identify all cases of BSI and device infection. The incidence of device infection was calculated with person-years of follow-up after device implantation. <h3>Results</h3> A total of 1524 patients with cardiac devices were included in the cohort. Total person-time of follow-up was 7578 years. The incidence of definite device infection was 1.9 per 1000 device-years (95% confidence interval [CI], 1.1-3.1). The incidence of pocket infection without BSI was 1.37 per 1000 device-years (95% CI, 0.62-3.05), and pocket infection with BSI or device-related endocarditis 1.14 per 1000 device years (95% CI, 0.47-2.74). The cumulative probability of device infection was higher among patients with defibrillators compared with those with pacemakers,<i>P</i>&lt;.001. Twelve (54.6%) of 22 cases of<i>Staphylococcus aureus</i>BSI had definite or possible cardiac device infection vs 3 (12.0%) of 25 cases of bloodstream infection due to gram-negative bacilli (<i>P</i> = .004). <h3>Conclusions</h3> To our knowledge, this is the first population-based study to describe the incidence of cardiac device infection. Device infection was common during episodes of<i>S aureus</i>BSI. The rate of cardiac device infection was higher in patients with defibrillators than in those with pacemakers.

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