Pacemaker Pocket Infection

Pacemaker pocket infection develops in the subcutaneous pocket that houses the pacemaker or ICD generator. It spans a spectrum ranging from superficial skin infection to deep pocket infection and systemic endocarditis.

Coagulase-negative staphylococci and S. aureus are the most common pathogens. Risk factors include intraprocedural contamination, pocket hematoma, skin erosion and immunosuppression. As rates of generator replacement have risen, infection rates have also increased.

Diagnosis is based on clinical examination, wound culture, blood cultures and transesophageal echocardiography. Deep pocket infection or systemic involvement requires removal of the entire system; superficial infections are only rarely managed with antibiotics alone.