Europace Advance Access published online on October 27, 2009
Europace, doi:10.1093/europace/eup334
CLINICAL RESEARCH
Prevalence of bacterial colonization of generator pockets in implantable cardioverter defibrillator patients without signs of infection undergoing generator replacement or lead revision
1 Cardiac Arrhythmia Center at the Heart Center of Ludwigshafen, Bremserstraße 79, Ludwigshafen D-67063, Germany; 2 Department of Medical Microbiology, Klinikum Ludwigshafen, Ludwigshafen, Germany
Aims: This study was designed to evaluate the prevalence of bacterial colonization of generator pockets in implantable cardioverter defibrillator (ICD) patients without signs of infection and to analyse the impact of bacterial colonization on the incidence of device infection during follow-up.
Methods and results: In 122 ICD patients undergoing generator replacement or surgical lead revision between January 2006 and July 2008, microbiological cultures of generator pockets and extracted leads were consecutively obtained. Patients with clinical evidence of a device infection were excluded. Positive cultures from the generator pocket and leads were found in 40 (33%) patients. The most common bacteria isolated were coagulase negative staphylococci (68%). During a median follow-up time of 203 days after the revision device infection occurred in three [7.5%, confidence interval (CI) 1.6–20.4%] patients with a positive culture vs. two (2.4%, CI 0.3–8.5%) patients with a negative culture (P = 0.33). Time from revision to infection was 108 ± 73 days in patients with positive culture vs. 60 ± 39 days in patients with negative culture (P = 0.50).
Conclusion: A third of ICD patients undergoing generator replacement or lead revision have an asymptomatic bacterial colonization of generator pockets. After revision 7.5% of these patients develop a device infection with the same species of microorganism.
Key Words: Device infection, ICD, Swab culture
* Corresponding author. Tel: +49 621 503 4332, Fax: +49 621 503 4028, Email: kleemann.thomas{at}web.de
Manuscript submitted 20 July 2009. Accepted after revision 30 September 2009.