TY - JOUR
T1 - Management and Outcome of Permanent Pacemaker and Implantable Cardioverter-Defibrillator Infections
AU - Sohail, Muhammad R.
AU - Uslan, Daniel Z.
AU - Khan, Akbar H.
AU - Friedman, Paul A.
AU - Hayes, David L.
AU - Wilson, Walter R.
AU - Steckelberg, James M.
AU - Stoner, Sarah
AU - Baddour, Larry M.
N1 - Funding Information:
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.
PY - 2007/5/8
Y1 - 2007/5/8
N2 - 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. aureus infection 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.
AB - 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. aureus infection 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.
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U2 - 10.1016/j.jacc.2007.01.072
DO - 10.1016/j.jacc.2007.01.072
M3 - Article
C2 - 17481444
AN - SCOPUS:34247464146
SN - 0735-1097
VL - 49
SP - 1851
EP - 1859
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 18
ER -