Authors : Kirti Parmar, Abhishek Sharma, Saurabh Rattan
DOI : 10.5083/ejcm
Volume : 14
Issue : 6
Year : 2024
Page No : 454-464
Introduction: Implantation of cardiac implantable electrophysiological devices (CIEDs), including permanent pacemakers and implantable cardioverter-defibrillators has been on the rise over the past years, largely due to the expanded indications for CIED implantation for primary prevention. Infection associated with implantable devices is a serious complication with high morbidity leading to mortality. The importance of appropriate empirical antibiotic coverage is illustrated by studies that document the association between inappropriate selection and increased mortality in patients with permanent pacemaker implantation. Increasing multi drug resistance problem could be due to mutations, over use of broad-spectrum antibiotics, across the counter availability of antibiotics and lack of infection control policy in the hospital settings. Methodology: A prospective observational study conducted at the major tertiary care centre of the State of Himachal Pradesh, for duration of one year. Patients who had undergone interventional cardiology procedure and developing any sign or symptom of general or systemic infection were included. Results: On direct Gram staining of clinical samples, microorganisms were seen in 12 (70.58%) samples and in 5 (29.41%) samples no microorganism seen. Out of 12 positive samples, Gram positive cocci were isolated from ten samples accounting for 83.33% of total isolates, while Gram negative bacilli were isolated from one sample (8.33%) and both Gram positive cocci and Gram- negative bacilli were isolated from single sample accounting for 8.33% of total isolates. Majority of the isolates were S.aureus (46%), followed by S.epidermidis (38%). Pseudomonas aeruginosa and Achromobacter spp. were 8% each. Out of 11 Staphylococcus isolates, 6 (54.54%) were identified as Staphylococcus aureus (S.aureus) and 5 (45.45%) were Staphylococcus epidermidis (S.epidermidis). There was 100% sensitivity to Vancomycin, Daptomycin and Linezolid. Almost 64% samples were resistant to Oxacillin, Cefoxitin, Cefazolin and Erythromycin; 45% were resistant to Co-trimoxazole and Clindamycin; 18% were resistant to Gentamicin and 9% were resistant to teicoplanin and Rifampicin. All the isolates were resistant to Ampicillin and Penicillin G. Out of 6 isolates of S.aureus, 3 (50%) were MRSA. Out of 5 isolates of S.epidermidis 4 (80%) were Methicillin resistant. All the MRSA isolates were sensitive to daptomycin, teicoplanin, vancomycin, linezolid and rifampicin but they were resistant to erythromycin, ampicillin and penicillin G. 67% isolates were sensitive to gentamicin, co-trimoxazole and clindamycin. All Methicillin resistant S.epidermidis were sensitive to daptomycin, vancomycin and linezolid. 75% were sensitive to gentamicin, teicoplanin and rifampicin and only 25% were sensitive to co-trimoxazole. However, all were resistant to erythromycin and clindamycin. In single isolate of Achromobacter spp resistance was observed for gentamicin, imipenem, meropenem, ciprofloxacin, levofloxacin and tetracycline. The isolate was sensitive to ceftazidime, piperacillin-tazobactam and co-trimoxazole. Single isolate of Pseudomonas aeruginosa was sensitive to amikacin, gentamicin, imipenem, meropenem, ceftazidime, cefepime, aztreonam, ciprofloxacin, levofloxacin and piperacillin-tazobactam. Conclusion: The present study indicated an infection rate of 8.1% following permanent pacemaker implantation. 84% of the causative organisms were Staphylococcus species and out of which 64% were methicillin resistant. Staphylococcus has been reported as a major cause of community and hospital acquired infections. Infections caused by Staphylococcus used to respond to β-lactam and related group of antibiotics. Vancomycin has been used as the drug of choice for treating MRSA infections. Further, the regular surveillance of hospital associated infections including monitoring antibiotic sensitivity pattern of MRSA and formulation of definite antibiotic policy may be useful for reducing the incidence of MRSA infection.