A historical perspective of pacemaker infections: 40-years single-centre experience
| Autor: | Ralph Schneider, Wolfgang Voss, Imke Wendig, Anne Hollstein, Jörg Lauschke, Georg H. Von Knorre, Dietmar Bänsch, Tina Tischer |
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| Rok vydání: | 2013 |
| Předmět: |
Male
Pacemaker Artificial medicine.medical_specialty Recurrent infections Prosthesis-Related Infections Time Factors Kaplan-Meier Estimate History 21st Century Time-to-Treatment Device removal Risk Factors Germany Physiology (medical) Antibiotic therapy Secondary Prevention medicine Retrospective analysis Humans Device Removal Aged Retrospective Studies Aged 80 and over business.industry Optimal treatment Age Factors History 20th Century Middle Aged Anti-Bacterial Agents Surgery Single centre Treatment Outcome Practice Guidelines as Topic Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | Europace. 16:235-240 |
| ISSN: | 1532-2092 1099-5129 |
| DOI: | 10.1093/europace/eut193 |
| Popis: | Aims The approach to infected cardiac devices has changed during recent decades. Optimal treatment is still a matter of debate, especially in pacemaker-dependent patients. Therefore, we investigated the management and outcome of patients with pacemaker infections in a single centre over four decades. Methods and results We conducted a retrospective analysis of 4212 patients and extracted those with pacemaker infections admitted to Rostock Heart Center between 1973 and 2012. One hundred and thirty-one consecutive patients (median age 69.6 ± 14.9 years) were admitted for device infections. Two-stage exchange was performed in 42 patients (32.8%). In 72 patients (55%), explantation and implantation on the contralateral side was performed simultaneously. In 17 cases the device was not replaced. Mean follow-up was 63 ± 81 months. Reinfection rate was 12.2%, which declined from 24% (1980s) to 2.6% (after 2000). Complete device removal (in 57.3%) reduced the risk for reinfection by 75% ( P = 0.02), as well as increasing age (0.049% per year, P = 0.001). One-stage exchange increased the risk of reinfection six-fold ( P = 0.021). Cultured bacteria after initiation of antibiotic therapy predicted a four-fold increase in risk of a recurrent infection ( P = 0.01). Conclusion Continuous assimilation of guidelines for pacemaker infection improved the outcome over time: complete extraction of the infected device seems to be highly desirable. A one-stage exchange increased the risk of recurrent device infection and should probably be avoided, but complete extraction seems to be more important than timing. |
| Databáze: | OpenAIRE |
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