Heart device may up risk of fatal blood infection

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Heart device may up risk of fatal blood infection

By Suzanne Rostler

NEW YORK, Aug 27 (Reuters Health) - Patients with pacemakers and other

implanted heart devices are at risk of a life-threatening bacterial blood

infection, new study findings suggest.

In many patients who developed Staphylococcus aureus bacteremia (staph

infection) and had a cardiac device implanted, the device was the source of

the infection. Often, these patients had no obvious signs of infection, even

after undergoing echocardiography, a procedure that allows doctors to view

the heart, researchers report in the August 28th issue of Circulation:

Journal of the American Heart Association.

The authors suggest that based on the study findings, doctors treating

patients who develop staph infections and have heart devices should suspect

that the device itself has become infected and consider surgically removing

it, rather than treating the blood infection with antibiotics.

In the study, conducted by researchers at Duke University, Durham, North

Carolina, patients who did not have the device removed were more likely to

die than patients who underwent the surgery to have their device taken out.

" In patients with Staphylococcus aureus bacteremia and an implanted cardiac

device, the likelihood that the device is infected is high, especially in

the first year after device placement, " Dr. Chamis, the study's

lead author, told Reuters Health. " Physicians must be more vigilant in

seeking out device infection with echocardiography and...blood cultures,

even if the physical examination does not suggest cardiac device infection. "

The Duke researchers found that 15 of 33 patients with an implanted heart

device developed a staph infection in the blood within 6 years. Nine of

these patients developed the infection within their first year of living

with the device.

In three of the nine patients, the infection originated in another part of

the body and spread to the heart device, while six cases were caused by the

device itself, the report indicates.

In most cases, there were no obvious signs that the device was infected,

such as redness or inflammation in the tissues covering the device, Chamis

and colleagues report. The infections were diagnosed on the basis of blood

tests.

According to the researchers, cardiac device infection of one kind or

another occurs in up to 20% of patients with a permanent pacemaker--a small

battery-operated device that helps the heart beat regularly, and in up to

1.3% of those with an implantable cardioverter-defibrillators, which shocks

the heart into a normal rhythm.

SOURCE: Circulation 2001;104.