Klug et al evaluated clinical findings associated with an infected pacemaker. Even subtle local signs may indicate an infected device and the need to completely remove it. The authors are from the University of Lille in France.
Patient selection: pacemaker with intravascular leads
Overt signs of infection:
(1) fistula, abscess or purulent discharge over the pacemaker
(2) positive blood cultures in 2 or more separate specimens
(3) endocarditis or vegetations associated with the leads
Subtle signs of infection:
(1) local pain and redness over the pacemaker
(2) impending exteriorisation (adherence of a lead or pulse generator to the skin without cutaneous breakthrough)
(3) frank exteriorisation (frank cutaneous breakthrough of the leads or pulse generator)
Observations:
(1) Local infection of the pacemaker or its leads has a significant risk of progression to a systemic infection.
(2) It is rare that an infection of a pacemaker is limited to the extravascular components. Failure to completely remove the leads of an infected pacemaker is associated with a high rate of reinfection.
(3) Antibiotic therapy is unlikely to correct the problem. If it is impossible to remove the leads or the patient refuses the procedure, then a prolonged course of antibiotic therapy with prolonged surveillance is necessary.
(4) Removal of an intravascular lead can be difficult and hazardous, but a delay in removal can make the removal more difficult and increases the risk of complications.
