Catanchin Andrei, Murdock Challon J, Athan Eugene
Department of Cardiology, Barwon Health (Geelong Hospital), Geelong, Vic. 3220, Australia.
Heart Lung Circ. 2007 Dec;16(6):434-9. doi: 10.1016/j.hlc.2007.02.097. Epub 2007 Apr 8.
Infection is a major complication of pacemaker and defibrillator (PPM/ICD) implantation. The experience in an Australian regional centre is reported.
Ten years' (1994-2004) cases of PPM/ICD infection retrospectively analysed and compared to overall insertion data; management and outcomes examined.
A total 39 cases (79.5% male, median age 71.3 years) identified, 24 in the primary centre where 1481 procedures performed (infection rate 1.6%). Patients with infection had average 2.2 procedures performed (odds ratio for infection if >1 procedure=4.7); 14 (36%) first implantations, 35 (90%) pacemakers, 11 (28%) recurrent. No difference in operation duration or difficulty between infected and non-infected cases. Infection in 18 cases (46%) involved lead/s, 16 (41%) generator and 5 (13%) both. Median time to presentation was 7.9 months. Echocardiography demonstrated lead vegetations in 8 cases. Organisms identified in 25 (64%)-92% Staphylococci (65% S. aureus); blood cultures positive in 18. PPM/ICD removed in 26 (67%), including lead/s in 89%; average hospital stay 37 days. One death attributable to PPM/ICD infection (mortality 2.6%), median follow-up 29.3 months.
A PPM/ICD infection rate of 1.6% (endocarditis 0.3%) demonstrated. Second and subsequent procedures carried almost 5 times greater infection risk.
感染是起搏器和除颤器（PPM/ICD）植入的主要并发症。本文报告了澳大利亚一个地区中心的相关经验。
回顾性分析了10年（1994 - 2004年）间PPM/ICD感染病例，并与总体植入数据进行比较；对治疗管理及结果进行了研究。
共识别出39例（男性占79.5%，中位年龄71.3岁），其中24例发生在进行了1481例手术的主中心（感染率1.6%）。感染患者平均接受了2.2次手术（若手术次数>1次，感染几率为4.7）；14例（36%）为首次植入，35例（90%）为起搏器，11例（28%）为复发性感染。感染病例与未感染病例在手术持续时间或难度上无差异。18例（46%）感染涉及导线，16例（41%）涉及发生器，5例（13%）两者均涉及。出现感染症状的中位时间为7.9个月。超声心动图显示8例导线有赘生物。25例（64%）鉴定出了病原体，其中92%为葡萄球菌（65%为金黄色葡萄球菌）；18例血培养呈阳性。26例（67%）移除了PPM/ICD，其中89%移除了导线；平均住院时间为37天。1例死亡归因于PPM/ICD感染（死亡率2.6%），中位随访时间为29.3个月。
PPM/ICD感染率为1.6%（心内膜炎为0.3%）。第二次及后续手术的感染风险几乎高出近5倍。
