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Pacemaker infections
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Pacemaker infections

  First I want to thank you for your quick reply to my earlier message "Infections". My father had 2 pacemaker infections within a nine month period, both requiring pacemaker removal and replacement.  It was very valuable to have some guidance and questions for my parents to ask his treating physician.   I have a follow-up question
   (my original message has already been archived at http://www.medhelp.org/perl6/cardio/archive/7218.html).  
  For this second infection, he was on oral antibiotics prior to and for the first week of his hospitalization.  They successfully removed without complication the pacemaker and old electrode from his first pacemaker (which lasted 10yrs). They then put him on  Vancomycin 1250mg daily infusion.  After 3-4 days of infusion a new pacemaker was inserted.  His second infection was isolated as Staph.  It is not clear whether the electrodes were the cause of the Staph infection.  He currently is completing the planned  2 weeks infusion therapy as an outpatient.
  What are potential causes of staph infection at site of pacemaker?
  Is a staph infection something that could have entered the body at a point other than the pacemaker insertion then migrated to the pacemaker?  
  Any comments on the current therapy?
  What are risks of occurrence of infection?
  What long term therapy, preventive care or monitoring should he anticipate or ask for?  Certainly he doesn't want to go through this every year.  
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Dear ML, thank you for your question.  From the information you've provided, it sounds like your father has been treated appropriately according to current clinical standards.  Staph infections usually originate from the skin and can be notoriously difficult to treat and virulent.  The staph infection may have originated at the pacemaker generator pocket site or may have originated somewhere else and infected the pacemaker leads through a bloodstream infection. I think it's difficult to determine the origin of the infection at this point.  Vancomycin is the most powerful anti-staph antibiotic that is available and your father appears to be on a proper dose and duration of therapy.  Additionally, the pacemaker leads needed to be changed because once a prosthetic device in the bloodstream becomes infected, it needs to be removed to successfully eradicate the infection. I can't comment on the risks of recurrent infection; that question is better directed to his physicians.  
Information provided in the heart forum is for general purposes only.  Specific diagnoses and therapies can only be provided by your physician.  Please feel free to write back with additional questions.  If you would like to make an appointment at the Cleveland Clinic Foundation, please call 1-800-CCF-CARE and ask for Desk F-25 or Desk F-15 in the Cardiology Department.  Good luck!





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