Methicillin-Resistant Organisms on the Rise after Cardiac Device Implantation

Methicillin-Resistant Organisms on the Rise after Cardiac Device Implantation

DALLAS—Methicillin-resistant organisms are increasingly common pathogens after a cardiac pacemaker or defibrillator has been implanted, according to data released at the American Heart Association’s Scientific Sessions 2005.

Investigators from the William Beaumont Hospital in Royal Oak, Mich, reviewed the records of all patients with suspected device infection from January 2000 to January 2005.

The data were analyzed according to whether patients had an infection before or after June 30, 2002.

Results showed that although a trend toward a decrease in device infection rates was evident in the latter time period, methicillin-resistant organisms were more common in the latter period.

“Given the increasing frequency of resistant organisms complicating device implantation, reconsidering the prophylactic antibiotic regimen may be appropriate for high-risk patients, such as those who have been recently hospitalized,” advised lead investigator David J. Rodriguez, MD, a resident in internal medicine.

During the observation period, 5188 pacemaker/defibrillator implants or generator changes or system revisions were performed.

Before June 30, 2002, 22 infections were documented, representing 1.02% of implants. In 7 (32%) patients, no organism could be cultured. Of 15 patients with positive cultures, 3 (20%) had methicillin-resistant organisms (2 were methicillin-resistant Staphylococcus aureus [MRSA]).

During the latter time period, 23 infections were documented, representing 0.76% of implants. Although 9% had negative cultures, 11 of 21 cultures (52%) had methicillin-resistant organisms; of these 8 were MRSA.

The analysis revealed that generator changes or revisions were associated with an increased rate of infection compared with de novo implants.

In addition, coagulase-negative staphylococcal infections were more common than S aureus infections.

“Our results show that while device infections are uncommon, methicillin-resistant organisms are increasingly common,” Dr Rodriguez said. “Vancomycin [Vancocin] should be considered for antibiotic prophylaxis in high-risk patients.”