Identification of Bacteriology and Risk Factor Analysis of Asymptomatic Bacterial Colonization in Pacemaker Replacement Patients

Abstract

BackgroundRecent researches revealed that asymptomatic bacterial colonization on PMs might be ubiquitous and increase the risk of clinical PM infection. Early diagnosis of patients with asymptomatic bacterial colonization could provide opportunity for targeted preventive measures.ObjectiveThe present study explores the incidence of bacterial colonization of generator pockets in pacemaker replacement patients without signs of infection, and to analyze risk factors for asymptomatic bacterial colonization.MethodsFrom June 2011 to December 2013, 118 patients underwent pacemaker replacement or upgrade. Identification of bacteria was carried out by bacterial culture and 16S rRNA sequencing. Clinical risk characteristics were analyzed.ResultsThe total bacterial positive rate was 37.3% (44 cases), and the coagulase-negative Staphylococcus aureus detection rate was the highest. Twenty two (18.6%) patients had positive bacterial culture results, of which 50% had coagulase-negative staphylococcus. The bacterial DNA detection rate was 36.4 % (43 cases). Positive bacterial DNA results from pocket tissues and the surface of the devices were 22.0% and 29.7%, respectively. During follow-up (median, 27.0 months), three patients (6.8%, 3/44) became symptomatic with the same genus of microorganism, S. aureus (n=2) and S. epidermidis (n=1). Multivariable logistic regression analysis showed that history of bacterial infection, use of antibiotics, application of antiplatelet drugs, replacement frequency were independent risk factors for asymptomatic bacterial colonization.ConclusionThere was a high incidence of asymptomatic bacterial colonization in pacemaker patients with independent risk factors. Bacterial culture combined genetic testing could improve the detection rate.

Predictors of Long-Term Infections After Cardiac Implantable Electronic Device Surgery ― Utility of Novel PADIT and PACE DRAP Scores ―

“…It is suggested that longer operating time is related to bacterial contamination. 20,22 Moreover, these finding indicate the great importance of operator experience and the necessity of maintaining a high annual number of operations.…”

“…One of the proposed strategies to reduce the CDI rate related to system replacement or upgrade procedures is removal of the fibrous capsule surrounding the device with electrocautery. 22 Recently, Goldenberg et al 24 indicated that capsule debridement significantly reduced the CDI risk (with hazard ratio 0.32). Moreover, prior reports also showed that capsule removal may facilitate the penetration of antibiotics routinely administered as prophylaxis of CIED procedures and thus prevent CDI development.…”