Bloom Heather, Heeke Brian, Leon Angel, Mera Fernando, Delurgio David, Beshai John, Langberg Jonathan
Division of Cardiology, Section of Cardiac Electrophysiology, Emory University School of Medicine, Atlanta, Georgia, USA.
Pacing Clin Electrophysiol. 2006 Feb;29(2):142-5. doi: 10.1111/j.1540-8159.2006.00307.x.
Pacemakers and implanted cardioverter defibrillator (ICD) infection rates are rising. Renal insufficiency impairs immune function and is known to increase the risk of infection following implantation of orthopedic hardware. The purpose of the current study is to characterize the risk factors for pacemaker and ICD infection and to evaluate the role of renal insufficiency in this complication.
A large (n = 4,856) single center experience with pacemaker and ICD procedures was reviewed. Of these, 141 were extractions of infected devices and 76 of these patients had been implanted in the Emory system and had preimplant creatinine information available for analysis. These cases were compared to 76 control patients undergoing device implantation matched by date of implant who had no infective complications. Demographic and clinical data from both groups were compared using both univariate and multivariate analysis. The overall rate of infection was 1.5%. Patients with device infection were more likely to have congestive heart failure (CHF), be diabetic, have generator exchanges, and to take warfarin than controls. There was no difference in the prevalence of coronary disease, atrial fibrillation, steroid use, or malignancy between the two groups. Elevated creatinine (Cr > or = 1.5 mg/dL) was much more frequent in patients with infection than in controls (38% vs 12%, odds ratio 4.6, P < 0.001). Moderate to severe renal disease (GFR < or = 60 cc/min/1.73 m2) was the most potent risk factor for infection, with a prevalence of 42% in infected patients versus 13% in controls (odds ratio of 4.8).
Renal insufficiency dramatically increases the risk of infection complicating pacemaker or ICD surgery. This association should be part of the risk-benefit consideration prior to device implantation. Additional study of more extensive perioperative antibiotic therapy in this subset of patients is warranted.
起搏器和植入式心脏复律除颤器（ICD）的感染率正在上升。肾功能不全损害免疫功能，已知会增加骨科植入物植入后感染的风险。本研究的目的是确定起搏器和ICD感染的危险因素，并评估肾功能不全在这一并发症中的作用。
回顾了一个大型（n = 4,856）单中心起搏器和ICD手术经验。其中，141例为感染装置的取出，这些患者中有76例在埃默里系统植入，且有植入前肌酐信息可供分析。将这些病例与76例同期植入装置且无感染并发症的对照患者进行比较。使用单因素和多因素分析比较两组的人口统计学和临床数据。总体感染率为1.5%。与对照组相比，发生装置感染的患者更易出现充血性心力衰竭（CHF）、糖尿病、更换发生器以及服用华法林。两组在冠心病、心房颤动、使用类固醇或恶性肿瘤的患病率方面无差异。感染患者中肌酐升高（Cr≥1.5 mg/dL）的情况比对照组更为常见（38%对12%，优势比4.6，P < 0.001）。中度至重度肾病（肾小球滤过率[GFR]≤60 cc/min/1.73 m²）是感染的最有力危险因素，感染患者中的患病率为42%，而对照组为13%（优势比为4.8）。
肾功能不全显著增加起搏器或ICD手术并发感染的风险。这种关联应成为装置植入前风险效益考量的一部分。有必要对这部分患者进行更广泛的围手术期抗生素治疗的进一步研究。
