CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 10, November 2012
AFRICA
e1
Case report
Infections secondary to pacemaker implantation:
a synopsis of six cases
AD KANE, MB NDIAYE, S PESSINABA, A MBAYE, M BODIAN, MED DRIOUCH, M JOBE, M DIAO, M SARR,
A KANE, SA BA
Abstract
Introduction:
Permanent cardiac pacing is a technique whose
indications have increased in the last 20 years. As with any
foreign body, pacemaker implantation is associated with the
risk of infection. The objective of this study was to describe
the clinical, paraclinical and treatment options of infections
secondary to pacemaker implantation at the Cardiology
Department of the Aristide le Dantec Teaching Hospital
(
CHUAristide le Dantec) in Dakar, Senegal.
Methods:
We conducted a retrospective study over a period
of three years (from January 2005 to December 2007) during
which pacemaker implantation was carried out in 107
patients.All patients with local and/or systemic signs of infec-
tion were included in our study.
Results:
The prevalence of infection in patients with pace-
makers was 5.6% in our series and infection occurred in three
women and three men, with a mean age of 66.2 years (range
23–83).
The delay time for the onset of clinical signs of infec-
tion was 6.6 months, with a range of eight days to 12 months.
The clinical signs were externalisation of the pacemaker with
suppuration (five cases), fever (one case) and inflammatory
signs (one case). Factors favouring the occurrence of infection
were co-morbidity (four cases), pre-operative length of stay
(
average eight days), use of temporary cardiac pacing (three
cases), the number of people in the theatre (average 4.5),
postoperative haematoma (one case) and repeating the surgi-
cal procedure (three cases).
Staphylococcus epidermidis
(
two
cases),
Staphylococcus aureus
(
two cases) and
Klebsiella pneu-
moniae
(
one case) were the organisms isolated at the local
site. Transthoracic echocardiography showed no objective
signs of endocarditis. The treatment was antibiotic therapy
for an average duration of 50.4 days after debridement of
the infected site (six cases). We noted four recurrences at six
months and one death from sepsis at 12 months.
Conclusion:
Infections secondary to pacemaker implanta-
tion are rare but serious. Their management is difficult and
requires the removal of the implanted material, hence the
importance of prevention of infection, or the removal and
re-implantation of the pacemaker at another site in cases of
infection. This is particularly important in our region where
pacemakers are very expensive.
Keywords:
pacemaker, infection, Dakar
Submitted 16/3/11, accepted 2/5/12
Cardiovasc J Afr
2012;
23
:
e1–e4
DOI: 10.5830/CVJA-2012-035
Permanent cardiac pacing is a technique whose indications
have increased in the last 20 years.
1
It is increasingly common
in Africa in general and in Senegal in particular. As with any
foreign body, pacemaker implantation is associated with risk
of infection of various degrees of severity, possibly leading to
bacteraemia and endocarditis.
2
These infections are associated
with a significant morbidity and mortality.
The objectives of this study were to describe the
epidemiological and clinical aspects, predisposing factors, and
the bacterial population associated with infection, as well as the
management of infections secondary to pacemaker implantation
at the Cardiology Department of the Aristide le Dantec Teaching
Hospital, Dakar, Senegal.
Methods
We conducted a retrospective study over a period of three years
from January 2005 to December 2007. During this period
permanent cardiac pacemakers were implanted in 107 patients
at the Cardiology Department of Aristide le Dantec Teaching
Hospital in Dakar.
The inclusion criteria were: the externalisation of the
pacemaker box or leads by scar dehiscence or skin necrosis;
local inflammatory signs (redness, swelling, pain, localised heat)
with or without externalisation of the pacemaker; local signs of
infection (skin necrosis, abscesses, purulent discharge) with or
without externalisation of the pacemaker; and local mechanical
signs (isolated pain, protrusion of a part of the pacemaker box
or lead).
The parameters studied were age, gender, indication for
cardiac pacing, predisposing factors (diabetes, cancer, long-term
treatment with corticosteroids or anticoagulants, presence of
postoperative haematoma, number of times the operation was
repeated, implantation with more than two leads, fever occurring
Cardiology Department, Aristide Le Dantec Teaching
Hospital, Dakar, Senegal
AD KANE, MD,
MB NDIAYE, MD
S PESSINABA, MD
A MBAYE, MD
M BODIAN, MD
MED DRIOUCH, MD
M JOBE, MB ChB
M DIAO, MD
M SARR, MD
A KANE, MD
SA BA, MD
