This topic was reviewed in a recent issue of Current Opinion in Cardiology.
Risk factors include the usual suspects such as diabetes, renal failure and steroid use. Infection rates seem to go up with the complexity of the procedure (pacemakers versus pacer-defibrillators versus defibrillator-resynchronization devices). The use of anticoagulants, via the increased incidence of pocket hematomas, may increase the risk. Device infections are increasing in frequency, probably reflecting an aging and more debilitated population of recipients as well as increasing complexity of devices.
Patients with devices who have staphylococcal bacteremia of uncertain source present a special problem which is dealt with in the review.
At the time of explantation the patient should be assessed for continued need for device therapy. Up to one third of patients may not require re-implantation. Those who do should have the device implanted on the contralateral side. The timing is controversial and is discussed in the review.