SEPTICEMIA AND ENDOCARDITIS - UNCOMMON BUT SERIOUS COMPLICATIONS IN CONNECTION WITH PERMANENT CARDIAC PACING

Between 1971-1978 septicemia was observed in 14 patients undergoing permanent pacemaker treatment. The causative microorganisms were as follows: Staphylococcus aureus (9), S. epidermidis (3), .alpha.-hemolytic streptococci + Proteus morganii (1), enterococci (1). In 4 patients, a mural endocarditis of the right atrial wall surrounding the electrode was found at operation or autopsy. The interval between the preceding pacemaker operation and onset of septicemia varied between 2 days and 23 mo. (median 2 mo.). In 5 patients, the last operation before septicemia was performed because of local infection in the pacemaker pocket or along the electrode. A probable portal of entry was found in 11 patients. The electrode was the origin in 8, the pacemaker pocket in 1 and a focus outside the pacemaker system in 2. Of the 6 patients treated with antibiotics alone, 3 were cured, 2 died and 1 is still on treatment. Eight patients underwent various surgical procedures in addition to the antibiotic treatment. In 4 the electrode was completely removed. In 2 of them cardiotomy during extracorporeal circulation had to be used. All of these patients were cured. In 3 the pacemaker system was partially extracted. Only 1 was cured, 1 developed osteomyelitis and 1 died. Based on this experience it is recommended that all foreign material should be removed, if possible, in the presence of septicemia and/or endocarditis, and that parenteral antibiotic treatment should be given for at least 6 wk.