Golzio Pier-Giorgio, Vinci Melissa, Anselmino Matteo, Comoglio Chiara, Rinaldi Mauro, Trevi Gian P, Bongiorni Maria Grazia
University Cardiology, Department of Internal Medicine, San Giovanni Battista Hospital, University of Turin, Torino, Italy.
Pacing Clin Electrophysiol. 2009 Mar;32 Suppl 1:S76-80. doi: 10.1111/j.1540-8159.2008.02257.x.
Pacemaker and implantable-cardioverter defibrillator lead infections widely increased with consequent need to accurately recognize responsible bacteria.
Between May 2003 and December 2007, we extracted 118 leads, 104 (87.3%) due to infections (sepsis, lead-associated endocarditis, pocket infection) or chronic draining sinus (with negative local bacteriological analyses). Swabs and tissue specimens from pocket and fragments of pin and tip of each extracted lead were obtained during extraction and sent for bacteriological examination.
Cultures from explanted lead pins returned positive results in 100% of the cases presenting with local infections and in 92.5% of those with chronic draining sinus. In cases of sepsis, positive results of blood samples are less common than lead samples (58.3 vs 86.7, P = 0.02), the latter being more sensitive for infection diagnosis. Concordance between bacterial isolates from pocket and lead is quite low, approaching 45%, seemingly due to contamination effect. Concordance between isolates within the lead (pin and tip) is quite high, close to 70%, reflecting a more accurate expression of the real infection. In cases of sepsis, concordance between lead and blood samples, and mainly from tip and blood, is very high, resembling 80-85%; consequently bacterial isolates from the lead, particularly from lead tip, are clearly associated with clinical infections.
Our results strongly support the hypothesis that chronic draining sinus is often sustained by infection. Moreover, diagnostic accuracy of lead samples is higher not only than swabs and tissue samples, but also than blood samples to confirm an infection and to guide effective therapy.
起搏器和植入式心脏复律除颤器导线感染显著增加，因此需要准确识别致病细菌。
2003年5月至2007年12月期间，我们取出了118根导线，其中104根（87.3%）是由于感染（败血症、导线相关的心内膜炎、囊袋感染）或慢性引流窦道（局部细菌学分析为阴性）。在取出导线时，从每个取出导线的囊袋以及针脚和尖端的碎片中获取拭子和组织标本，并送去进行细菌学检查。
在出现局部感染的病例中，取出导线针脚的培养结果100%呈阳性，在慢性引流窦道病例中，这一比例为92.5%。在败血症病例中，血样的阳性结果比导线样本少见（58.3%对86.7%，P = 0.02），导线样本对感染诊断更敏感。囊袋和导线的细菌分离株之间的一致性相当低，接近45%，这似乎是由于污染效应。导线内部（针脚和尖端）分离株之间的一致性相当高，接近70%，反映了实际感染的更准确表现。在败血症病例中，导线和血样之间的一致性，主要是尖端和血样之间的一致性非常高，接近80%-85%；因此，导线的细菌分离株，特别是导线尖端的分离株，与临床感染明显相关。
我们的结果有力地支持了慢性引流窦道常由感染所致的假说。此外，导线样本的诊断准确性不仅高于拭子和组织样本，也高于血样，有助于确诊感染并指导有效治疗。
