Baños R, Gómez J, Sánchez B, de la Morena G, Simarro E, García del Real F
Servicio de Medicina Interna, Hospital Universitario Virgen de la Arrixaca, Murcia.
Enferm Infecc Microbiol Clin. 2000 Jun-Jul;18(6):267-70.
The prevalence of infection of permanent pacemaker ranges from 0.13 to 19.9%. Our objective is to review our experience and to analyze the epidemiology and treatment of those diagnosed as having pacemaker lead endocarditis.
A retrospective study include all cases diagnosis of pacemaker endocarditis in our hospital, since 1991 to 1998. Eleven patients with pacemaker endocarditis were included.
Eleven patients were admitted for endocarditis related to pacemaker-lead infection. Fever occurred in nine patients (81.8%). A germ was isolated in nine patients (81.8%) and was a Staphylococcus in eight (88.9%). Transthoracic echocardiography demonstrated vegetations in only two patients (18.2%), whereas transesophageal echocardiography disclosed abnormal appearances on the pacemaker lead in eleven patients (100%). Six patients were treated with antibiotics initially and four patients required the removal of the whole infected material after finishing treatment with antibiotic. Five patients were treated since the beginning with a electrode removal who responded favorably.
The diagnosis of endocarditis related to pacemaker infection should be suspected in the presence of fever and patient with pacemaker. Transesophageal echocardiography should be performed to look for vegetations. S. aureus and S. epidermidis are involved in the majority of these infections. The best treatment is an immediate removal of the entire pacing system and antimicrobial therapy.
永久性起搏器感染的发生率为0.13%至19.9%。我们的目的是回顾我们的经验，并分析那些被诊断为起搏器导线心内膜炎患者的流行病学情况及治疗方法。
一项回顾性研究纳入了我院1991年至1998年期间所有诊断为起搏器心内膜炎的病例。共纳入11例起搏器心内膜炎患者。
11例患者因与起搏器导线感染相关的心内膜炎入院。9例患者（81.8%）出现发热。9例患者（81.8%）分离出病原菌，其中8例（88.9%）为葡萄球菌。经胸超声心动图仅在2例患者（18.2%）中显示有赘生物，而经食管超声心动图在11例患者（100%）中发现起搏器导线上有异常表现。6例患者最初接受抗生素治疗，4例患者在抗生素治疗结束后需要移除整个感染物质。5例患者从一开始就接受了电极移除治疗，效果良好。
对于有发热的起搏器患者，应怀疑存在与起搏器感染相关的心内膜炎。应进行经食管超声心动图检查以寻找赘生物。这些感染大多数由金黄色葡萄球菌和表皮葡萄球菌引起。最佳治疗方法是立即移除整个起搏系统并进行抗菌治疗。
