Surveillance Cultures and Infection in 230 Pacemaker and Defibrillator Generator Changes in Pediatric and Adult Congenital Patients.
Webster G, Balmert LC, Patel AB, Kociolek LK, Gevitz M, Olson R, Chaouki AS, El-Tayeb O, Monge MC, Backer C.World J Pediatr Congenit Heart Surg. 2021 May;12(3):331-336. doi: 10.1177/2150135120988631.PMID: 33942684
Take Home Points:
- Cardiac implantable electronic device (CIED) procedures may be complicated by pulse generator pocket infections
- Currently guidelines do not support surveillance cultures at the time of pulse generator replacement but data in pediatric and congenital heart disease are lacking
- In this single center study, no difference in outcomes was observed with surveillance cultures in a pediatric and congenital heart disease population
Commentary by Dr. Jeremy Moore (Los Angeles) Congenital and Pediatric Cardiac EP Chief section editor:
Pulse generator pocket infections are uncommon but potentially severe complications after CIED procedures and are more common at the time of replacement and especially device upgrades. The utility of surveillance cultures at the time of pulse generator replacement has been shown to be of limited utility but has not been studied specifically in the pediatric and adult congenital heart disease populations. The present study sought to evaluate the results of routine pocket surveillance cultures in a group of 123 patients (76% congenital heart disease) undergoing pulse generator replacement at the Northwestern University from 2010 to 2017.
In the surveillance cohort, no clinical pocket infection was observed. However, 12 (9.8%) cases produced a positive culture (aerobic culture , anaerobic culture , both aerobic and anaerobic culture ). In 10 of 12 culture, bacteria growth was minimal suggesting low bacterial inoculum. Three cases with positive cultures received antibiotics beyond the peri-procedural period. In a comparison cohort of 107 cases without surveillance cultures, there were 2 suspected pocket infections that were both treated with 2-3 weeks of antibiotics not requiring further intervention after long term follow up. The authors concluded that surveillance cultures at their institution did not materially affect clinical outcomes in their CIED population.
This present work evaluated the utility of surveillance cultures at the time of pulse generator replacement. Although a small study, these data are consistent with the overall adult data whereby surveillance cultures are not recommended at the time or routine CIED replacement procedures.