Sonication of explanted cardiac devices detected bacterial colonization in 38% of cases without clinical signs of infection, compared to 27% detected by conventional swab cultures.
Observational (n=121)
No
Does sonication detect bacterial colonization on explanted electrophysiological cardiac devices compared to conventional swab culture?
A significant proportion of electrophysiological cardiac devices are colonized by bacteria without clinical signs of infection, which can be effectively detected using sonication.
Absolute Event Rate: 38% vs 27%
BACKGROUND: Electrophysiological cardiac devices are increasingly used. The frequency of subclinical infection is unknown. We investigated all explanted devices using sonication, a method for detection of microbial biofilms on foreign bodies. METHODS AND RESULTS: Consecutive patients in whom cardiac pacemakers and implantable cardioverter/defibrillators were removed at our institution between October 2007 and December 2008 were prospectively included. Devices (generator and/or leads) were aseptically removed and sonicated, and the resulting sonication fluid was cultured. In parallel, conventional swabs of the generator pouch were performed. A total of 121 removed devices (68 pacemakers, 53 implantable cardioverter/defibrillators) were included. The reasons for removal were insufficient battery charge (n=102), device upgrading (n=9), device dysfunction (n=4), or infection (n=6). In 115 episodes (95%) without clinical evidence of infection, 44 (38%) grew bacteria in sonication fluid, including Propionibacterium acnes (n=27), coagulase-negative staphylococci (n=11), Gram-positive anaerobe cocci (n=3), Gram-positive anaerobe rods (n=1), Gram-negative rods (n=1), and mixed bacteria (n=1). In 21 of 44 sonication-positive episodes, bacterial counts were significant (>or=10 colony-forming units/mL of sonication fluid). In 26 sterilized controls, sonication cultures remained negative in 25 cases (96%). In 112 cases without clinical infection, conventional swab cultures were performed: 30 cultures (27%) were positive, and 18 (60%) were concordant with sonication fluid cultures. Six devices and leads were removed because of infection, growing Staphylococcus aureus, Streptococcus mitis, and coagulase-negative staphylococci in 6 sonication fluid cultures and 4 conventional swab cultures. CONCLUSIONS: Bacteria can colonize cardiac electrophysiological devices without clinical signs of infection.
Rohacek et al. (Tue,) conducted a observational in Patients undergoing removal of cardiac pacemakers and implantable cardioverter/defibrillators (n=121). Sonication fluid culture vs. Conventional swab culture was evaluated on Detection of bacterial colonization in devices without clinical evidence of infection. Sonication of explanted cardiac devices detected bacterial colonization in 38% of cases without clinical signs of infection, compared to 27% detected by conventional swab cultures.
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