Chapter 12 : Pacemaker and Defibrillator Infections

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This chapter discusses infections related to pacemakers (PMs) or implantable cardioverter defibrillators (ICDs) are major complications and are difficult to manage; complete removal of the device is required in a majority of cases. Many factors such as diabetes, underlying malignancy, corticosteroids, anticoagulation, and advanced age have been suspected as potential predisposing factors for developing a device-related infection, but only some of them can nowadays be considered as well characterized independent risk factors. The diagnosis of a device-related infection can be difficult to establish. The clinical presentation depends on many variables, including the site of infection (the pulse-generator pocket and/or the conducting system), the type of electrode implanted (epicardial or intraventricular transvenous), the route of contamination (erosion, wound or pocket infection, secondary to a bacteremia, or contiguous spread from an adjacent infectious focus), and the microorganism involved. In summary, the diagnosis of an implanted device-related infection must be suspected in the presence of any erosion of an implanted device, chronic fever without documented infectious foci, multiple pulmonary infiltrates or emboli, and/or persistent or relapsing evidence of infection at the insertion site. Despite strong microbiological and epidemiological data suggesting that local contamination with the flora present in the skin appendages might contaminate the wound margin during the surgical procedure and be responsible for a majority of device-related infections, systemic antibiotic prophylaxis has remained controversial. Almost all authors report the necessity for assiduous skin disinfection before surgery, and others employ intrapocket antibiotic spray or instillation before insertion.

Citation: Eggimann P, Waldvogel F. 2000. Pacemaker and Defibrillator Infections, p 247-264. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch12

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Autopsy: vegetation closely related to the lead of an implanted pacemaker. (From reference , with permission.)

Citation: Eggimann P, Waldvogel F. 2000. Pacemaker and Defibrillator Infections, p 247-264. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch12
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Table 1

PM-related infections in series published since 1979

Citation: Eggimann P, Waldvogel F. 2000. Pacemaker and Defibrillator Infections, p 247-264. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch12
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Table 2

Infections according to different types of ICD

Citation: Eggimann P, Waldvogel F. 2000. Pacemaker and Defibrillator Infections, p 247-264. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch12
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Table 3

Clinical characteristics of PM-related infections in series ( ≥ 10 cases) published since 1979

Citation: Eggimann P, Waldvogel F. 2000. Pacemaker and Defibrillator Infections, p 247-264. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch12
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Table 4

Comparison of series (n ≥5 cases) of patients with PM endocarditis published since 1979

Citation: Eggimann P, Waldvogel F. 2000. Pacemaker and Defibrillator Infections, p 247-264. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch12
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Table 5

Guidelines for antimicrobial therapy of implanted device-related infections

Citation: Eggimann P, Waldvogel F. 2000. Pacemaker and Defibrillator Infections, p 247-264. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch12

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