Implantable insulin pumps: Infections most likely due to seeding from skinflora determine severe outcomes of pump-pocket seromas

Complications at implantation site of implantable insulin pumps may lead to premature removal. To elucidate the origins and the outcomes of these loca l adverse events. We investigated seromas of the 'pump-pocket' that have been detected for an eight month-period during the follow-up of such-treated forty type 1 diabe tic patients. At the start of study period, skin bacterial flora was sample d at umbilicus and groin, and isolated strains of Staphylococcus epidermidi s were preserved in specific vials at -20 degreesC. Each time a seroma was detected at transcutaneous 45 days-refill of pump reservoir, it was sampled for bacterial cultures. Isolated strains of S. epidermidis from seroma wer e genetically compared to preserved strains of corresponding patients using Pulsed-Field Gel Electrophoresis (PFGE) after genomic restriction by SmaI. Among the ten seromas that occurred after a mean time of 9.9 months since i mplantation, S. epidermidis were isolated in five cases. Genetic comparison of isolated strains could be performed in three cases. Compared strains sh owed identical (in 2 cases) or closely related (in one case) PFGE profiles. While the five aseptic seromas resolved with rest, four infected cases req uired explantations after one to nineteen months in spite of antibiotic the rapy and the fifth one persisted without impairment under long-term antibio tics. Our results suggest that seeding from the skin flora is a key-factor determ ining the severity of pump-pocket complications. We recommend that bacteria l investigations of pump-pocket seromas should be systematically performed, while prophylactic measures might include antibiotic cover for each punctu re of the pump-pocket.