Staphylococcus aureus bacteremia in patients with permanent pacemakers or implantable cardioverter-defibrillators

Anna Lisa Chamis, Gail E. Peterson, Christopher H. Cabell, G. Ralph Corey, Robert A Sorrentino, Ruth Ann Greenfield, Thomas Ryan, L. Barth Reller, Vance G. Fowler

Research output: Contribution to journalArticle

223 Scopus citations

Abstract

Background - Although cardiac device infections (CDIs) are a devastating complication of permanent pacemakers or implantable cardioverter-defibrillators, the incidence of CDI in patients with bacteremia is not well defined. The objective of this study was to determine the incidence of CDI among patients with permanent pacemakers or implantable cardioverter-defibrillators who develop Staphylococcus aureus bacteremia (SAB). Methods and Results - A cohort of all adult patients with SAB and permanent pacemakers or implantable cardioverter-defibrillators over a 6-year period was evaluated prospectively. The overall incidence of confirmed CDI was 15 of 33 (45.4%). Confirmed CDI occurred in 9 of the 12 patients (75%) with early SAB (<1 year after device placement). Fifteen of 21 patients (71.5%) with late SAB (≥1 year after device placement) had either confirmed (6 of 21, 28.5%) or possible (9 of 21, 43%) CDI. In 60% of the patients (9 of 15) with confirmed CDI, no local signs or symptoms suggesting generator pocket infection were noted. Conclusions - The incidence of CDI among patients with SAB and cardiac devices is high. Neither physical examination nor echocardiography can exclude the possibility of CDI. In patients with early SAB, the device is usually involved, and ≅40% of these patients have obvious clinical signs of cardiac device involvement. Conversely, in patients with late SAB, the cardiac device is rarely the initial source of bacteremia, and there is a paucity of local signs of device involvement. The cardiac device is involved, however, in ≥28% of these patients.

Original languageEnglish (US)
Pages (from-to)1029-1033
Number of pages5
JournalCirculation
Volume104
Issue number9
DOIs
StatePublished - Aug 28 2001
Externally publishedYes

Keywords

  • Echocardiography
  • Infection
  • Pacemakers

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    Chamis, A. L., Peterson, G. E., Cabell, C. H., Corey, G. R., Sorrentino, R. A., Greenfield, R. A., Ryan, T., Reller, L. B., & Fowler, V. G. (2001). Staphylococcus aureus bacteremia in patients with permanent pacemakers or implantable cardioverter-defibrillators. Circulation, 104(9), 1029-1033. https://doi.org/10.1161/hc3401.095097