Chronic infection was diagnosed in

Chronic infection was diagnosed in 12 patients , which we define as presenting with an asymptomatic erosion of device hardware through the skin or presenting more than 1 month after symptom onset.Most patients(26 of 28, 93%)had positive blood, wound, or lead tip cultures.Staphylococcal species were the most common pathogens.They were cultured from 21 patients(75%)and were evenly divided between methicillin-sensitive, methicillin-resistant, and coagulase-negative species(Figure 2).Two patients presented with persistent enterococcal bacteremia.Other organisms included Pseudomonas aeruginosa, E. coli, Enterobacter species, and Klebsiellapneumoniae.Acuteinfections were predominantlycausedby methicillin-sensitiveor methicillin-resistant staphylococci(12 of 16 patients, 75%).Chronic infections were predominantly caused by coagulase-negative staphylococci or gram negative bacilli(8 of 12 patients, 67%).Five patients had vegetations seen on either the leads or the heart valves by trans-esophageal echocardiography.Extraction procedures were performed an ave