Europace Advance Access originally published online on July 25, 2008
Europace 2008 10(9):1067-1072; doi:10.1093/europace/eun191
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Implantable Cardioverter-Defibrillators
High prevalence of asymptomatic bacterial colonization of rhythm management devices
1 Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Strasse, D-30625 Hanover, Germany; 2 Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany; 3 Helmholtz Center for Infection Research (former GBF), Braunschweig, Germany
Aims: Recent work has been focused on causes of and risk factors for rhythm management device infections. The aim of this study was to elucidate whether patients may be asymptomatic carriers of bacteria on their rhythm management device, possibly allowing later manifestation of infection.
Methods and results: A total of 108 devices were changed for battery depletion between April 2005 and February 2006 in asymptomatic patients who were examined for evidence of bacterial DNA on the device and in the surrounding tissue using single strand conformation polymorphism analysis (SSCP). Follow-up was for 23.4 months. In 47.2% of the patients, bacterial DNA was demonstrated on the device, which had been in place for 64.1 months. The sequences identified bacterial strains that are untypical for clinical device infections. Staphylococci were demonstrated in only 3.7% of the patients and they became symptomatic within the observation interval; all others remained asymptomatic. The known risk factors for device infections did not correlate with the demonstration of bacterial DNA in this population. Common cohabitation was identified among the strains found.
Conclusion: A large proportion of patients carry bacteria on their pacemaker or implantable cardioverter defibrillator asymptomatically. The strains found differ from those commonly seen in clinically evident device infections. Common risk factors for device infection did not correlate with the presence of DNA.
Key Words: Infection, Rhythm management devices, Pacemakers, Defibrillators, Risk factors, Device changes
* Corresponding author. Tel: +49 511 532 3453; fax: +49 511 532 8158. E-mail address: pichlmaier.maximilian{at}mh-hannover.de
Manuscript submitted 21 May 2008. Accepted after revision 2 July 2008.