Dy Chua Jimmy, Abdul-Karim Ahmad, Mawhorter Steven, Procop Gary W, Tchou Patrick, Niebauer Mark, Saliba Walid, Schweikert Robert, Wilkoff Bruce L
Department of Pathology, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA.
Pacing Clin Electrophysiol. 2005 Dec;28(12):1276-81. doi: 10.1111/j.1540-8159.2005.00268.x.
The isolation of a pathogen is vital in the diagnosis and treatment of a device infection. A swab culture, despite poor sensitivity, is the most common method used in specimen collection.
To determine the relative value of swab and tissue specimen cultures in patients with implantable cardiac pacemakers and defibrillators.
Prospective patient cohort study.
A 1,000-bed tertiary referral center in Cleveland, Ohio.
Consecutive patients with implantable cardiac pacemaker or defibrillator presenting for lead extraction from October 1, 2000 to March 31, 2001.
Tissue and swab cultures were prospectively collected during pacemaker and implantable defibrillator surgeries that required lead extraction. Clinical manifestations, microbiology, and echocardiographic data were recorded in patients with and without a clinical diagnosis of device system infection.
Seventy-one patients with implantable pacemaker (n = 49, 69%), implantable defibrillator (n = 18, 25%), or both devices (n = 4, 6%) requiring lead extraction had pocket swab and tissue cultures for analysis. Infection was evident clinically in 35 (49%) of the patients and absent in the remainder. The most common bacteria isolated were coagulase-negative Staphylococcus (37%) and Staphylococcus aureus (10%). Patients with clinical infection had positive cultures more frequently (P = 0.002) by pocket tissue culture (n = 24, 69%) than by swab culture (n = 11, 31%). However, patients without clinical infections had positive cultures at similar rates by pocket tissue culture (n = 10, 28%) and by swab culture (n = 8, 22%; P = 0.48). Patients without clinical infection were not treated with other than perioperative antibiotics, and did not develop clinical infections.
Pocket tissue cultures are more effective than pocket swab cultures for the isolation and identification of the infectious pathogens in cardiac device infections. Positive cultures by pocket swab or tissue cultures in the absence of clinical signs and symptoms of infection does not imply infection or the need for specific therapy.
病原体的分离对于器械感染的诊断和治疗至关重要。拭子培养尽管敏感性较差，但仍是标本采集最常用的方法。
确定拭子和组织标本培养在植入式心脏起搏器和除颤器患者中的相对价值。
前瞻性患者队列研究。
俄亥俄州克利夫兰市一家拥有1000张床位的三级转诊中心。
2000年10月1日至2001年3月31日期间连续的因导线拔除而就诊的植入式心脏起搏器或除颤器患者。
在需要导线拔除的起搏器和植入式除颤器手术期间前瞻性地采集组织和拭子培养物。记录有或无器械系统感染临床诊断的患者的临床表现、微生物学和超声心动图数据。
71例需要导线拔除的植入式起搏器患者（n = 49，69%）、植入式除颤器患者（n = 18，25%）或两种器械都有的患者（n = 4，6%）进行了囊袋拭子和组织培养以进行分析。35例（49%）患者临床上有明显感染，其余患者无感染。分离出的最常见细菌是凝固酶阴性葡萄球菌（37%）和金黄色葡萄球菌（10%）。有临床感染的患者通过囊袋组织培养（n = 24，69%）比通过拭子培养（n = 11，31%）更频繁地出现培养阳性（P = 0.002）。然而，无临床感染的患者通过囊袋组织培养（n = 10，28%）和拭子培养（n = 8，22%；P = 0.48）出现培养阳性的比例相似。无临床感染的患者除围手术期抗生素外未接受其他治疗，也未发生临床感染。
囊袋组织培养在心脏器械感染中分离和鉴定感染病原体方面比囊袋拭子培养更有效。在无感染临床体征和症状的情况下，囊袋拭子或组织培养阳性并不意味着感染或需要特定治疗。
