Sohail Muhammad R, Uslan Daniel Z, Khan Akbar H, Friedman Paul A, Hayes David L, Wilson Walter R, Steckelberg James M, Stoner Sarah, Baddour Larry M
Division of Infectious Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
J Am Coll Cardiol. 2007 May 8;49(18):1851-9. doi: 10.1016/j.jacc.2007.01.072. Epub 2007 Apr 23.
We describe the management and outcome of permanent pacemaker (PPM) and implantable cardioverter-defibrillator (ICD) infections in a large cohort of patients seen at a tertiary care facility with expertise in device lead extraction.
Infection is a serious complication of PPM and ICD implantation. Optimal care of patients with these cardiac device infections (CDI) is not well defined.
A retrospective review of all patients with CDI admitted to Mayo Clinic Rochester between January 1, 1991, and December 31, 2003, was conducted. Demographic and clinical data were collected, and descriptive analysis was performed.
A total of 189 patients met the criteria for CDI (138 PPM, 51 ICD). The median age of the patients was 71.2 years. Generator pocket infection (69%) and device-related endocarditis (23%) were the most common clinical presentations. Coagulase-negative staphylococci and Staphylococcus aureus, in 42% and 29% of cases, respectively, were the leading pathogens for CDI. Most patients (98%) underwent complete device removal. Duration of antibiotic therapy after device removal was based on clinical presentation and causative organism (median duration of 18 days for pocket infection vs. 28 days for endocarditis; 28 days for S. aureus infection vs. 14 days for coagulase-negative staphylococci infection [p < 0.001]). Median follow-up after hospital discharge was 175 days. Ninety-six percent of patients were cured with both complete device removal and antibiotic administration.
Cure of CDI is achievable in the large majority of patients treated with an aggressive approach of combined antimicrobial treatment and complete device removal. Based on findings of our large retrospective institutional survey and previously published data, we submit proposed management guidelines of CDI.
我们描述了在一家具有设备导线拔除专业技术的三级医疗机构中，大量永久性起搏器（PPM）和植入式心脏复律除颤器（ICD）感染患者的管理及结局。
感染是PPM和ICD植入的严重并发症。对于这些心脏设备感染（CDI）患者的最佳治疗方案尚无明确界定。
对1991年1月1日至2003年12月31日期间入住梅奥诊所罗切斯特分院的所有CDI患者进行回顾性研究。收集人口统计学和临床数据，并进行描述性分析。
共有189例患者符合CDI标准（138例PPM，51例ICD）。患者的中位年龄为71.2岁。发生器囊袋感染（69%）和与设备相关的心内膜炎（23%）是最常见的临床表现。凝固酶阴性葡萄球菌和金黄色葡萄球菌分别在42%和29%的病例中为CDI的主要病原体。大多数患者（98%）接受了完整设备移除。设备移除后抗生素治疗的持续时间基于临床表现和致病微生物（囊袋感染的中位持续时间为18天，心内膜炎为28天；金黄色葡萄球菌感染为28天，凝固酶阴性葡萄球菌感染为14天[p < 0.001]）。出院后的中位随访时间为175天。96%的患者通过完整设备移除和抗生素治疗得以治愈。
对于大多数采用抗菌治疗与完整设备移除相结合的积极治疗方法的患者，CDI是可以治愈的。基于我们大型回顾性机构调查的结果以及先前发表的数据，我们提出了CDI的管理指南建议。
