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A Population-Based Study

Daniel Z. Uslan, MD; Muhammad R. Sohail, MD; Jennifer L. St. Sauver, PhD; Paul A. Friedman, MD; David L. Hayes, MD; Sarah M. Stoner, MS; Walter R. Wilson, MD; James M. Steckelberg, MD; Larry M. Baddour, MD

Arch Intern Med. 2007;167(7):669-675.

Background  The incidence of cardiac device infection is not well understood. Bloodstream infection (BSI) in patients with permanent pacemakers or implantable cardioverter-defibrillators (hereafter, defibrillators) may reflect device infection.

Methods  Retrospective, population-based cohort study of all adult patients with cardiac devices who resided in Olmsted County, Minnesota, from 1975 to 2004. The medical linkage-system of the Rochester Epidemiology Project and standardized criteria were used to identify all cases of BSI and device infection. The incidence of device infection was calculated with person-years of follow-up after device implantation.

Results  A total of 1524 patients with cardiac devices were included in the cohort. Total person-time of follow-up was 7578 years. The incidence of definite device infection was 1.9 per 1000 device-years (95% confidence interval [CI], 1.1-3.1). The incidence of pocket infection without BSI was 1.37 per 1000 device-years (95% CI, 0.62-3.05), and pocket infection with BSI or device-related endocarditis 1.14 per 1000 device years (95% CI, 0.47-2.74). The cumulative probability of device infection was higher among patients with defibrillators compared with those with pacemakers, P<.001. Twelve (54.6%) of 22 cases of Staphylococcus aureus BSI had definite or possible cardiac device infection vs 3 (12.0%) of 25 cases of bloodstream infection due to gram-negative bacilli (P = .004).

Conclusions  To our knowledge, this is the first population-based study to describe the incidence of cardiac device infection. Device infection was common during episodes of S aureus BSI. The rate of cardiac device infection was higher in patients with defibrillators than in those with pacemakers.

Author Affiliations: Department of Medicine, Divisions of Infectious Diseases (Drs Uslan, Wilson, Steckelberg, and Baddour) and Cardiovascular Diseases (Drs Friedman and Hayes), and Department of Health Sciences Research (Dr St. Sauver and Ms Stoner), Mayo Clinic College of Medicine, Rochester, Minn; and Division of Infectious Diseases, Department of Medicine, Tawam Hospital/Johns Hopkins Medicine, Al Ain, United Arab Emirates (Dr Sohail). Dr Uslan is now with the Division of Infectious Diseases, University of California, Los Angeles, David Geffen School of Medicine at UCLA.

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