Author + information
- Received October 2, 2006
- Revision received December 11, 2006
- Accepted January 2, 2007
- Published online May 8, 2007.
- Muhammad R. Sohail, MD⁎,⁎,1 (, )
- Daniel Z. Uslan, MD⁎,3,
- Akbar H. Khan, MD‡,2,
- Paul A. Friedman, MD†,
- David L. Hayes, MD†,
- Walter R. Wilson, MD⁎,
- James M. Steckelberg, MD⁎,
- Sarah Stoner, MS§ and
- Larry M. Baddour, MD⁎
- ↵⁎Reprint requests and correspondence:
Dr. Muhammad R. Sohail, Department of Medicine, Division of Infectious Diseases, Tawam Hospital/Johns Hopkins Medicine, P.O. Box 15258, Al Ain, Abu Dhabi, United Arab Emirates.
Objectives We describe the management and outcome of permanent pacemaker (PPM) and implantable cardioverter-defibrillator (ICD) infections in a large cohort of patients seen at a tertiary care facility with expertise in device lead extraction.
Background Infection is a serious complication of PPM and ICD implantation. Optimal care of patients with these cardiac device infections (CDI) is not well defined.
Methods A retrospective review of all patients with CDI admitted to Mayo Clinic Rochester between January 1, 1991, and December 31, 2003, was conducted. Demographic and clinical data were collected, and descriptive analysis was performed.
Results A total of 189 patients met the criteria for CDI (138 PPM, 51 ICD). The median age of the patients was 71.2 years. Generator pocket infection (69%) and device-related endocarditis (23%) were the most common clinical presentations. Coagulase-negative staphylococci and Staphylococcus aureus, in 42% and 29% of cases, respectively, were the leading pathogens for CDI. Most patients (98%) underwent complete device removal. Duration of antibiotic therapy after device removal was based on clinical presentation and causative organism (median duration of 18 days for pocket infection vs. 28 days for endocarditis; 28 days for S. aureusinfection vs. 14 days for coagulase-negative staphylococci infection [p < 0.001]). Median follow-up after hospital discharge was 175 days. Ninety-six percent of patients were cured with both complete device removal and antibiotic administration.
Conclusions Cure of CDI is achievable in the large majority of patients treated with an aggressive approach of combined antimicrobial treatment and complete device removal. Based on findings of our large retrospective institutional survey and previously published data, we submit proposed management guidelines of CDI.
↵1 Dr. Sohail is currently at Tawam Hospital/Johns Hopkins Medicine, Al Ain, United Arab Emirates
↵2 Dr. Khan is currently at Emory University School of Medicine, Atlanta, Georgia
↵3 Dr. Uslan is currently at David Geffen School of Medicine, University of California at Los Angeles, California.
This work was supported in part by the Enhance Award (Department of Medicine), Small Grants Program (Division of Infectious Diseases), and research funds from the Division of Cardiology, Mayo Clinic College of Medicine. Dr. Hayes received honoraria from Medtronic, Guidant, St. Jude Medical, ELA Medical, and Biotronik; sponsored research from Medtronic, Guidant, and St. Jude Medical; is on the medical advisory board of Guidant; and is a steering committee member of Medtronic. Dr. Friedman received honoraria from or is a consultant for Medtronic, Guidant, and AstraZeneca; sponsored research from Medtronic, AstraZeneca via Beth Israel, Guidant, St. Jude, and Bard; and holds intellectual property rights with Bard EP, Hewlett Packard, and Medical Positioning, Inc. Dr. Baddour received royalty payments from Elsevier and UpToDate and is an ACP/PIER editorial consultant.
Data presented in part at the 43rd Annual Meeting of the Infectious Diseases Society of America, October 6 to 9, 2005, San Francisco, California (abstract no. 387).
- Received October 2, 2006.
- Revision received December 11, 2006.
- Accepted January 2, 2007.
- American College of Cardiology Foundation