Am J Cardiovasc Dis 2012;2(2):116-122

Original Article
The prevalence of methicillin resistant organisms among pacemaker and
defibrillator implant recipients

David J Rodriguez, Aisha Afzal, Rudolph Evonich, David E Haines

Department of Cardiovascular Medicine, Oakland University William Beaumont School of Medicine, Beaumont Health
System, Royal Oak, MI, USA.

Received March 1, 2012; accepted March 23, 2012; Epub May 15, 2012; Published June 15, 2012

Abstract: Introduction: Pacemaker and defibrillator infections are an uncommon, but catastrophic complication of device
implantation. The present study examined the prevalence of device-related infections, the patterns of antibiotic resistance,
and the presence of methicillin resistant staphylococcus aureus (MRSA) nares colonization in device implant recipients.
Methods: Two protocols were employed using a retrospective and a prospective analysis. A retrospective chart review of
218 patients with suspected device infection from 1/2000 to 1/2011 was performed. Demographics, infection rates, and
patterns of antibiotic resistance were compared. The prospective analysis enrolled one hundred eighty two patients
undergoing device implantations or generator replacements. The nares were swabbed and analyzed for the presence of
staphylococcus aureus, and tested for methicillin sensitivity. Results: Over a period of ten years, 12,771 device
implants/generator changes/system revisions were performed, with an infection rate of 1.2%. Methicillin resistance (MR)
was identified in 98/218 (44.9%) of patients. Those with MR infection had more diabetes and cardiomyopathy. There was
no significant increase in methicillin resistance over time (p=0.30). Our prospective analysis included 110 men. A total of
32 patients (17.6%) had positive cultures for SA: 6.6% with MRSA. Patients positive for MRSA nares colonization had a
statistically significant greater length of hospital stay 8.5 days (mean) versus 4.4 days (P=0.049). Conclusions: Methicillin
resistant organisms appear to be emerging and persistent pathogens in device implants. The screening of MRSA
colonization may identify new populations at risk. Further studies and analysis are needed to determine the cost
effectiveness of a screening protocol. (AJCD1203002).

Keywords: Pacemaker infections, MRSA infections, methicillin resistant infections, nares colonization, pacemaker
generator changes, antibiotic prophylaxis


Address all correspondence to:
Dr. David E Haines
Department of Cardiovascular Medicine
Oakland University William Beaumont School of Medicine
Heart Rhythm Center, Beaumont Health System
3601 West 13 Mile Road, Royal Oak, MI 48073, USA.
Tel: 248-898-4198; Fax 248-898-0986
E-mail: dhaines@beaumont.edu
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