Pacemakerinfection Casepresentation
,Candy
AliceHoMiuLingNethersoleHospital
,81-years-old
PresenPacemakerinfection Casepresentation
,Candy
AliceHoMiuLingNethersoleHospital
,81-years-old
Presentedwithrecurrentsyncope
Holtershowedsicksinussyndrome
VVIimplantedinJuly2005,procedureuneventful
InAccidentandEmergencydepartment(AED),
AttendedAEDinOct,2005andcomplainedofpacerwoundpainandswelling
Treatedascellulitiswithampicillinandcloxacillin
3dayslater,attendedAEDagainforincreasingpacerwoundpainandswelling
IncisionanddrainagewasdoneinAED!!
Referredtogeneralclinicforwounddressing!!
Noticedpacemakerexposedbygeneralclinicnurse
Admittedtomedicalwardandcardiologistwastheninformedatthisjuncture
Openwoundwithpacerexposed
Afebrile
Treatedasinfectedpacingwoundwithexposureofthepacerbox
Emergencyoperationarrangedandpacerwasremoved
Woundswabsweretaken
Pocketwascleanedbyhydrogenperoxide
Putonacourseofcefazolin
Asthepatientremainedasymptomaticafterremovalofpacer,herefusedtohavepacemakerimplantation
Followedup,
Noticedhavepainfulerythematouslesionwithscalingandpus-likedischargeatlateraledgeofpacingsite
Woundwasexploredandcleanedagain
Cloxacillinwasgiven
WoundswabsyieldMSSAinbothoccasions
However,granulomadevelopedoverthepacerwoundagain
Cauterizationbysilvernitratetriedbutfailed
Surgeronwasconsultedforsurgicalremovalofgranulomatogetherwiththeunderlyingandsurroundingtissue(?duetotheirritationofthetissuebythepacingleadsorunderlyingchronicinfection)
Granulomaregrewaftersurgery
Eventually,patientwasreferredtoQueenElizabethHospitalforremovalofpacingleadbylasersheathduetosuspectedleadinfection
PrevalenceofCardiacDeviceimplantation
Infectionofpermanentpacemakersystemsisuncommon,occurringinapproximately~1-7%ofimplantedpacingsystem
Amongstudyperiod,therewasa49%riseinnumberofnewdevicesimplantation(from159,585in1996to237,720in2003)
160%forICDsand31%PMs
-fold(-foldforPMs,6-fol
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