A recent study found permanent pacemaker infection
(PPMI) in 2.09% patients, with infections more prevalent in devices implanted
over 12 months prior. Diabetes and Hypertension were the most common
comorbidities. Culture-negative infections predominated, followed by methicillin-resistant Staphylococcus aureus(MRSA).
These
findings are published in October 2025, in Indian Heart Journal.
The
Clinical Burden of Device-Related Infections
Cardiac
implantable electronic devices (CIEDs), including permanent pacemakers, are
considered lifesaving for appropriately selected patients. Due to expanding
indications and increased life expectancy, more devices are being implanted in
elderly patients and those with multiple comorbidities, which inherently
increases their risk profile. Device-related infection remains one of the most
dreaded complications, as it is associated with significant morbidity, recurrent
hospitalizations, escalated healthcare costs, and even mortality. Historically,
the incidence of infection rates for these devices has varied widely, ranging
from 0.5% to 6% in earlier case series, underscoring the need for localized
data to inform best practices. The present study aimed to specifically analyze
the incidence, associated risk factors, and microbiology of PPMI within a
regional context.
Study
Overview
This
retrospective, hospital-based observational study was conducted at a single tertiary care facility. The analysis included 802 patients
who underwent CIED implantation, focusing specifically on 648 patients who
received Permanent Pacemakers (PPMs). The study analyzed PPM indications,
patient demographics, comorbidities, and the microbiology of any subsequent
infections. Inclusion was limited to patients presenting with local
inflammatory signs or purulent discharge, while patients under 18 years or
those with ICD/CRT infections were excluded. Clinically, all included patients
initially received intravenous Teicoplanin, followed by oral
amoxicillin/clavulanic acid. When PPMI was diagnosed using standard
international criteria, the standard management involved removal of the
infected device and leads; once the infection was resolved, a sterilized
generator was typically reimplanted contralaterally.
The
Key findings from the study include:
Among the 716 patients included in the
final analysis, the incidence of PPMI was found to be 2.09% (15 patients). The majority of patients received
dual-chamber devices (52.8%).
The most frequent indication for PPM
implantation was Complete Heart Block (66.2% of PPM patients).
Notably, the infection risk was
highest for devices that had been implanted more than 12 months prior (40% of all PPMI cases), indicating a
substantial rate of delayed infection.
When analyzing the 15 patients with
PPMI, hypertension was the most common
associated risk factor (60%), closely followed by diabetes (46.67%).
Microbiologically, the most striking
finding was the high rate of culture-negative
pacemaker infections (53.33%). Among identified pathogens, methicillin-resistant Staphylococcus aureus (MRSA) dominated, accounting for
33.33% of the infections.
Clinical Relevance and Targeted Prevention
For
practicing physicians, this study highlights that PPMI incidence (2.09%) aligns
with global trends, but importantly, 40% of infections occurred more than a
year post-implantation—underscoring the need for long-term vigilance and
awareness of subclinical pocket colonization. The high proportion of
culture-negative infections (53%) means clinicians should not dismiss infection
when cultures are negative, especially in patients with prior antibiotic
exposure or suspected fastidious organisms. MRSA emerging as the most common
pathogen reinforces the dominant role of Staphylococci in device infections.
Hypertension and diabetes, prevalent in the infected cohort, underscore the
importance of optimizing these comorbidities before and after implantation.
Overall, meticulous procedural technique, strong infection-prevention
strategies, and aggressive management of risk factors remain essential to
improving long-term device outcomes.
Reference: Kapoor M, Gunasekaran AK, Lyngdoh V, Kynta RL, Das PP.
Incidence and risk factors of pacemaker pocket infection–an observational
study. Indian Heart Journal. 2025 May 25.