Sustained Bacteremia in 26 Patients with a Permanent Endocardial Pacemaker: Assessment of Wire Removal

Abstract

We reviewed the data on 26 patients with permanent endocardial pacemakers who had 28 episodes of bacteremia to determine whether removal of the wire is required. Patients recovered completely from the first episode in seven of 20 cases of staphylococcal bacteremia and in six of six cases of nonstaphylococcal bacteremia (P = .015). Definitive cure was not achieved during the first episode in seven cases of staphylococcal bacteremia related to the pacing system when the wire was not withdrawn; however, cure was achieved in five of six cases when the whole pacemaker was removed (P < .01). The duration of treatment was longer for the patients from whom the wire was not removed during the first episode (P < .01). Whether cases of staphylococcal bacteremia were related to the pacing system or not, the rate of recovery of the responsible microorganism from the wires was similar for both groups of patients (six [82%] of seven and three [75%] of four, respectively). Nonstaphylococcal bacteremia was unrelated to the pacing system in five of six cases; these patients were all cured without removal of the wire.

Pacemaker Related Endocarditis. Analysis of Seven Cases.

“…Blood cultures play an important role in the diagnostic process in cases with suspected infective endocarditis. According to the literature, the most frequently encountered pathogens isolated from blood, wound, and electrode cultures of patients with pacemaker associated sepsis include coagulase positive and coagulase negative staphylococci (80%), 2,[6][7][8][9][10][11]14,15,20,21) and this is consistent with the blood culture findings of most of our patients. Echocardiography is of pivotal importance in the diagnosis of pacemaker-associated endocarditis.…”

“…1) Coagulase negative and positive staphylococci are responsible for most of the infections. [1][2][3][4][5][6][7][8][9][10][11] Echocardiography, as in native and prosthetic valve endocarditis, plays a crucial role in the diagnosis of pacemaker endocarditis. In order to eradicate an infection in permanent pacemaker related endocarditis and septicemia, the pacemaker system should be completely removed either percutaneously or surgically in addition to intensive antibiotic treatment.…”

Device-Related Endocarditis and Infected Leads Extraction: The Dark Side of The Moon

“…As in the study by Camus et al, the high rate of uncontrolled infection or relapse among patients with septicemia in relation to PMmaterial infection confirms the need for (Camus et al 1993). Moreover immediate removal of the entire pacing system should be performed in all cases both for systemic infection related to PM-lead contamination and for infection of the PM pocket or the subcutaneous part of the lead (Panidis et al 1984).…”

Aspergillus Infection in a Large Thrombus of a Permanent Ventricular Pacing Lead

“…These include the sensitivity of most fungi to amphotericin B, the known failure of antimicrobial therapy alone to cure either Aspergillus endocarditis or pacemaker infection (2), and the success of surgical removal of bacterially infected pacemaker systems (18). Therefore, the treatment of choice would be surgical removal of infected pacemaker system and associated vegetations combined with systemic administration of amphotericin B (14).…”

“…The estimated incidence of the infection after permanent endocardial pacemaker implantation varies from 0.2% to 3% (2). Fungal infections of pacemakers are particularly rare.…”