Blood infection should prompt rapid assessment of patient’s hardware

DEAR DR. ROACH »

My son had a pacemaker placed in

2013 and got it checked every four months.

He developed an ulcer on his coccyx. He was being seen every two or three weeks in a wound clinic, and I was told it was 98% healed. The visiting nurse came between visits to the doctor and sent him to the emergency room because of a bad odor. The ER said he had a wound and blood infection. Because he had a pacemaker, they said they would check it. It was checked a week later, and he died two days after that. I was told he died because his pacemaker wires were infected. Should someone have caught this problem? I am thinking my son died due to a medical error. — Anon.

ANSWER » I am very sorry about your son. I don’t have enough information to say for sure a medical error was responsible for his death; however, the story is concerning.

An ulcer on the sacrum is usually a sign of debility and immobility, which puts a person at risk for medical complications. If the wound was deeper than the doctors realized, it could have led to bacteremia — that is, bacteria in the blood.

People with ANY kind of medical hardware need to be very concerned about bacteremia, since no matter how well the device is put in, it is at risk for being infected (what we call “seeded”) by the bacteria.

Bacteria can go anywhere blood goes. Infection around a pacer wire is extremely serious and usually requires surgical removal of the infection, which in turn requires great expertise.

A week seems too long, especially in hindsight, to let the pacemaker leads go without evaluation. I’m publishing your letter in hopes that other people in a situation like your son’s know to get prompt evaluation of any hardware they have that is in contact with blood, such as a pacemaker or automated implantable car di overt er defibrillator, in a situation of bacteremia (blood infection).