Chua J D, Wilkoff B L, Lee I, Juratli N, Longworth D L, Gordon S M
Department of Infectious Disease, S32, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
Ann Intern Med. 2000 Oct 17;133(8):604-8. doi: 10.7326/0003-4819-133-8-200010170-00011.
Optimal treatment of infections related to implantable electrophysiologic cardiac devices is poorly defined.
To describe the clinical presentation, treatment, and outcome of patients with such infections.
Retrospective case series.
The Cleveland Clinic Foundation, Cleveland, Ohio.
123 patients with infections involving implantable cardiac electrophysiologic devices.
Demographic characteristics, clinical manifestations, time to diagnosis, management, and outcome.
87 patients with permanent pacemakers and 36 patients with implantable cardioverter defibrillators had infections. The most common signs and symptoms were pocket erythema and local pain. The most common pathogens were coagulase-negative staphylococci (68%) and Staphylococcus aureus (23%). In 117 patients (95%), all equipment was extracted and antibiotic therapy lasted a median of 28 days. Operative mortality was zero. Follow-up showed crude mortality and relapse rates of 8% and 3%, respectively.
For infections related to implantable electrophysiologic devices, complete device removal and antimicrobial therapy allow timely, successful reimplantation at a remote anatomic site without substantial risk for operative mortality or recurrent infection.
与植入式心脏电生理设备相关的感染的最佳治疗方法尚不明确。
描述此类感染患者的临床表现、治疗方法及结果。
回顾性病例系列研究。
俄亥俄州克利夫兰市的克利夫兰诊所基金会。
123例涉及植入式心脏电生理设备感染的患者。
人口统计学特征、临床表现、诊断时间、治疗及结果。
87例永久性起搏器患者和36例植入式心脏转复除颤器患者发生感染。最常见的体征和症状是囊袋红斑和局部疼痛。最常见的病原体是凝固酶阴性葡萄球菌（68%）和金黄色葡萄球菌（23%）。117例患者（95%）取出了所有设备，抗生素治疗持续时间中位数为28天。手术死亡率为零。随访显示粗死亡率和复发率分别为8%和3%。
对于与植入式心脏电生理设备相关的感染，完全取出设备并进行抗菌治疗可使患者在远离原解剖部位及时、成功地重新植入设备，且手术死亡率或反复感染的风险不大。
