SOPENA B, CRESPO M, BEIRAS X, GARCIA E, RIVERA A, DELA-FUENTE J, MARTINEZ-VAZQUEZ C; Interscience Conference on Antimicrobial Agents and Chemotherapy.

Abstr Intersci Conf Antimicrob Agents Chemother Intersci Conf Antimicrob Agents Chemother. 1999 Sep 26-29; 39: 630 (abstract no. 1680).

Internal Med.-Infectious Disease Unit Hosp. Xeral, Vigo, SPAIN

BACKGROUND: Although bacteremia in patients with permanent transvenous pacemaker (PTP) is a serious problem, the reported literature on this topic is scarce and agreement among authors about management, does not exist. We report our experience on this issue.METHODS: The pacing files of the 1182 PTP implanted between May/87 and Dec/98 were reviewed. The criteria for bacteremia was two positive blood cultures for the same microorganism. Patients with only one positive blood culture were included if the same microorganism was recovered from the generator pocket. Bacteremias were classified as early-onset when they occured within the first 6 months after the implantation, and late-onset when they occured thereafter.RESULTS: From 16 patients, 27 episodes of bacteremia were gathered (88.8% by Staphylococcus sp.). The source of bacteremia was the PTP in 12 patients. 4 patients had a portal of entry other than the pacing system. 8 patients had early-onset bacteremia and S. aureus (all metecilin-susceptible) was isolated in 75% of them (6/8). The system was removed by traction in 7 cases, and 3 patients died after the procedure (in-group mortality 37.5%). 7 patients had late-onset bacteremia and coagulase-negative Staphylococcus was isolated in 5/8 (62.5%). All patients transiently improved with antibiotics, but relapsed after withdrawal. Total recovery was completed only after the removal of the system. The PTP was retired by traction in 4 patients and no deaths were registered. Three (20%) and four (26.6%) patients fulfilled the Dukes criteria for definite and probable endocarditis respectively. Vegetations were visualized by Transthoracic Echocardiography in any patient.CONCLUSIONS: PTP-related endocarditis is more frequent than previously reported. Transesophagyc Echocardiography should be performed in all patients with pacemaker-related bacteremia. In most patients with Staphylococcal bacteremia, total removal of the pacing system is necessary for cure.

Publication Types:

• Meeting Abstracts

Keywords:

• Anti-Bacterial Agents
• Bacteremia
• Echocardiography
• Humans
• Pacemaker, Artificial
• Staphylococcal Infections
• ultrasonography

Other ID:

• GWAIDS0008710

UI: 102246207

From Meeting Abstracts