Ho Ivan C K, Milan David J, Mansour Moussa C, Mela Theofanie, Guy Mary L, Ruskin Jeremy N, Ellinor Patrick T
Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, 02114, USA.
Heart Rhythm. 2006 Aug;3(8):919-23. doi: 10.1016/j.hrthm.2006.04.012. Epub 2006 Apr 20.
With the increasing use of implantable cardioverter-defibrillators (ICDs), device complications are becoming more common. Fungal-related ICD infections have rarely been reported, and little is known about the presentation, prevalence, and treatment options for these morbid infections.
The purpose of this study was to characterize the clinical features, treatment, and outcomes of patients with fungal ICD infections.
We performed a retrospective review of ICD procedures performed at a single academic center and identified all ICD-related infections managed between 1983 and 2005.
Among a total of 3,648 ICD-related procedures performed between 1983 and 2005, we identified 47 (1.3%) cases of ICD infections, of which 5 (0.1%) were due to a fungal pathogen. Fungal infections were more likely to be associated with abdominal devices, to have a local rather than systemic infection, and to have a longer duration from the original implant to presentation. All patients were treated with ICD system explantation and antifungal therapy.
Fungal infection of ICDs is a rare but serious complication of device implantation that must be treated aggressively with complete hardware explantation and prolonged antifungal therapy. Because most infections are late complications and have indolent onsets, a high level of clinical suspicion is required for early diagnosis.
随着植入式心脏复律除颤器（ICD）使用的增加，设备并发症越来越常见。与真菌相关的ICD感染鲜有报道，对于这些严重感染的表现、患病率及治疗选择知之甚少。
本研究旨在描述真菌性ICD感染患者的临床特征、治疗及预后。
我们对在一个学术中心进行的ICD手术进行了回顾性研究，并确定了1983年至2005年间所有与ICD相关的感染病例。
在1983年至2005年间进行的总共3648例与ICD相关的手术中，我们确定了47例（1.3%）ICD感染病例，其中5例（0.1%）是由真菌病原体引起的。真菌感染更可能与腹部设备相关，为局部而非全身感染，且从最初植入到出现感染的时间更长。所有患者均接受了ICD系统取出及抗真菌治疗。
ICD真菌感染是设备植入的一种罕见但严重的并发症，必须通过彻底取出硬件及延长抗真菌治疗进行积极治疗。由于大多数感染是晚期并发症且起病隐匿，早期诊断需要高度的临床怀疑。
