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A pacemaker infection is a bacterial infection that affects the area around the pacemaker battery, just under the skin on the chest wall; the area around the wires leading from the heart to the battery; or a combination of the two. It is most likely to occur as a result of outside contamination during the first few days to weeks after the implantation of a pacemaker. It also may occur after any invasive procedure involving the pacemaker, including a battery change, wire repair, or cardiac catheterization.
The electronic device that is a pacemaker is surgically inserted into a person's chest wall as a way of ensuring that the person's heart maintains a steady rhythm. It can be used to treat bradycardia, which is a heart beat of well under 60 beats per minute, or tachycardia, which is a heart rate that is far too fast. A temporary pacemaker can be used to temporarily regulate a heart rate, and infections are more common with these devices, part of which remains outside the body.
Doctors often prescribe preventive antibiotics at the time of pacemaker surgery in an attempt to ward off any potential infections. Signs of such an infection include pain and fever. A pacemaker infection also can interfere with the effectiveness of the pacemaker and may make it necessary to remove the device.
A primary pacemaker infection is most often a deep infection in the pocket of skin made for the device or in the tissue surrounding the area. It can be traced to a contaminated device or bacterial contamination at the time the device was implanted. These infections are rare because of the sterile surgical conditions involved in the pacemaker implantation procedure.
A secondary pacemaker infection can occur around the tissue where the device is placed or where the wires rest; it is the result of bacteria entering the blood system. For example, patients who have developed a bacteremia, or blood infection, from a cut or from dental work may have those same bacteria migrate and cause a pacemaker infection. Such pacemaker infections are more common and can go undiagnosed, leading to endocarditis, a serious infection of the muscle layers of the heart.
A localized pacemaker infection that has redness and swelling around the insertion site or the pocket of skin that holds the device will be treated with intravenous antibiotics for 14 to 21 days. Any apparent drainage from the site will be cultured to ensure that the antibiotics used are the right ones to treat the bacteria. More serious pacemaker infections involving the wires, the pocket of skin surrounding the device, or a systemic blood infection from another source must be treated with aggressive antibiotic therapy and surgical removal of the contaminated device. A temporary external pacemaker may be needed while the infection is eliminated before a clean, sterile new device can be implanted.
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