BACKGROUND: Most device related infections are currently treated by extraction, while conservative treatment is considered nearly obsolete. Information on best treatment for apparent superficial (S) implantable device pocket infection (DPI) is scarce.
OBJECTIVE: We sought to evaluate the characteristics and the appropriate initial treatment of patients presenting with (S)DPI, defined as clinical signs of local infection (redness, swelling, local warm) without any signs of major complications (MC) such as bacteremia, endocarditis, fistula, exudate or persistent fever.
SUBJECTS AND METHODS: In a retrospective data analysis of the years 2007-2014 in our clinic, we detected 54 patients with DPI, who were treated at our center. Our primary end point was the outcome of patients who were treated conservatively as compared to those treated by extraction.
RESULTS: A total of 54 patients (age: 65±14 yr, 72% male) with DPI presentation were included.
24 patients-(44%) had MC and immediate extraction was performed.
30 patients-(56%) showed only signs of (S)DPI and were initially treated conservatively with antibiotics.
Of the patients initially treated conservatively, 15 patients-(50%)(group-A) had recovery.
Rest of 15 patients-(50%)(group-B) treated conservatively, had to have extraction at a later stage, among them (94%) had recurrence/persistence of the infection, (40%) developed later bacteremia, (54%) developed sepsis, and (27%) developed endocarditis.
When comparing the two groups that were treated conservatively, the two important differences were that the infection developed after initial pacemaker implantation in 53% in group-A vs. 20% in group-B.
There was a history of prior pocket infection in 20% in group-A, and 93% in group-B.
CONCLUSIONS: 50% of patients with (S)DPI , treated conservatively, had full recovery without extraction. However those who failed conservative treatment had serious consequences. Further studies should concentrate on identifying the subgroup that may benefit from this approach, probably those with first implantation and no prior history of pocket infection.
