Pacemaker-related endocarditis - Report of 7 cases and review of the literature

We report on 7 patients with pacemaker endocarditis diagnosed during the wo rkup of long-standing fever. Persistent positive blood cultures and echocar diography led to the diagnosis in 6 patients whereas autopsy was diagnostic in another. Causative microorganisms were Staphylococcus epidermidis (3), Staphylococcus lugdunensis (1), Pseudomonas aeruginosa (1), Streptococcus b ovis (1), and Streptococcus mitis-Streptococcus sanguis (1), Pulmonary embo lism was present in nearly 50% of the cases, a figure clearly higher than p reviously reported. In all but 1 case the initial medical approach was not successful, and thus the pacing system was finally removed. None of the cas es relapsed after the removal. We have reviewed the literature regarding pa cemaker endocarditis, particularly with respect to treatment.