Uslan Daniel Z, Baddour Larry M
Department of Medicine, Division of Infectious Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
Curr Opin Infect Dis. 2006 Aug;19(4):345-8. doi: 10.1097/01.qco.0000235160.78302.24.
Use of electrophysiologic devices (permanent cardiac pacemaker and implantable cardioverter/defibrillator) has been increasing. Infection of these cardiac devices is a devastating complication, and medical treatment alone without device removal is often unsuccessful and frequently leads to infection relapse. This article reviews recent publications that address the diagnosis and management of infected electrophysiologic devices.
Recent studies have shed new light on the incidence, risk factors, management, and outcome of cardiac device infection. Rates of both cardiac device implantation and infection have been increasing, although the rate of increase of cardiac device infection has outdistanced that of implantation and this has had enormous economic and clinical consequences.
The large majority of cardiac device infections are likely due to pocket site contamination at the time of device placement. Hematogenous seeding from a distant focus of infection, particularly due to Staphylococcus aureus, can account for late-onset infection. Although no prospective studies have been conducted to date, management with parenteral antibiotics and complete device removal is the current standard of care. Further study is needed to better define optimal diagnostic and management interventions, particularly in patients with bloodstream infection and no local chest wall or echocardiographic evidence of cardiac device infection.
电生理设备（永久性心脏起搏器和植入式心脏复律除颤器）的使用一直在增加。这些心脏设备的感染是一种毁灭性的并发症，仅进行药物治疗而不取出设备往往是不成功的，并且经常导致感染复发。本文综述了近期关于感染性电生理设备诊断和管理的出版物。
近期研究为心脏设备感染的发生率、危险因素、管理和结果提供了新的见解。心脏设备植入率和感染率都在上升，尽管心脏设备感染的上升速度超过了植入率，这产生了巨大的经济和临床后果。
绝大多数心脏设备感染可能是由于设备植入时囊袋部位污染所致。远处感染灶的血行播散，尤其是由金黄色葡萄球菌引起的，可导致迟发性感染。尽管迄今为止尚未进行前瞻性研究，但目前的护理标准是采用静脉抗生素治疗并完全取出设备。需要进一步研究以更好地确定最佳诊断和管理干预措施，特别是对于有血流感染且无局部胸壁或超声心动图证据表明存在心脏设备感染的患者。
