מתוך medicontext.co.il
WESTPORT, CT (Reuters Health) – The incidence of infection of implanted pacemakers or cardioverter-defibrillators among patients with Staphylococcus aureus bacteremia may be higher than previously thought, according to a report in Circulation: Journal of the American Heart Association for August 28.
Researchers estimate that about 70% of S. aureus bacteremia patients who have an implanted cardiac device may also have a devise infection. Other studies have shown that the incidence of cardiac device infection from S. aureus bacteremia ranges up to about 20%, lead author Dr. Anna Lisa Chamis told Reuters Health.
Dr. Chamis and colleagues from Duke University Medical Center in Durham, North Carolina, evaluated 33 patients with implanted pacemakers or cardioverter-defibrillators who presented with S. aureus bacteremia over a 6-year period. The investigators believe that this is perhaps the largest prospective study to date
Cardiac device infection was confirmed in 15 of these patients. "The majority of device infections showed no obvious signs," Dr. Chamis commented in a journal statement.
Among the 12 patients who had their device implanted within 1 year of infection, 9 had confirmed device infections, as did 6 patients whose device had been implanted for longer than a year.
Device infection was suspected in another nine patients, but these patients died of sepsis before device infection could be confirmed, she added.
Cardiac device infection is not always apparent, especially when the infection involves the generator pocket. Sixty percent of the patients with confirmed device infection showed no "clinically detectable signs of generator pocket infection," the researchers note.
Physicians with implanted-device patients who develop S. aureus bacteremia should be very worried that the device may be infected, Dr. Chamis said. Device infection results in increased morbidity and mortality and, if the infected device is not replaced, there is an increased risk of death, she warned.
If the device becomes infected, it should be replaced, Dr. Chamis said. "If the device is not infected, then the patient should receive an extended course of antibiotics. If the results of testing are uncertain, then patients should be closely followed with serial blood cultures."
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