Pacemaker infections: a 10-year experience

BACKGROUND: Infection is a major complication of pacemaker and defibrillator (PPM/ICD) implantation. The experience in an Australian regional centre is reported. METHODS: Ten years' (1994-2004) cases of PPM/ICD infection retrospectively analysed and compared to overall insertion data; management and outcomes examined. RESULTS: A total 39 cases (79.5% male, median age 71.3 years) identified, 24 in the primary centre where 1481 procedures performed (infection rate 1.6%). Patients with infection had average 2.2 procedures performed (odds ratio for infection if >1 procedure=4.7); 14 (36%) first implantations, 35 (90%) pacemakers, 11 (28%) recurrent. No difference in operation duration or difficulty between infected and non-infected cases. Infection in 18 cases (46%) involved lead/s, 16 (41%) generator and 5 (13%) both. Median time to presentation was 7.9 months. Echocardiography demonstrated lead vegetations in 8 cases. Organisms identified in 25 (64%)-92% Staphylococci (65% S. aureus); blood cultures positive in 18. PPM/ICD removed in 26 (67%), including lead/s in 89%; average hospital stay 37 days. One death attributable to PPM/ICD infection (mortality 2.6%), median follow-up 29.3 months. CONCLUSIONS: A PPM/ICD infection rate of 1.6% (endocarditis 0.3%) demonstrated. Second and subsequent procedures carried almost 5 times greater infection risk.