Baylor College of Medicine, Department of Medicine, Section of Infectious Diseases, One Baylor Plaza, BCM 286, Room N1319, Houston, TX 77030, USA.
Circulation. 2010 May 18;121(19):2085-91. doi: 10.1161/CIRCULATIONAHA.110.936708. Epub 2010 May 3.
Along with the rising use of cardiac implantable electronic devices (CIEDs), there has been a disproportional increase in the number of infections of such devices. Little is known about nonstaphylococcal CIED-related infections, which make up approximately 10% to 30% of all CIED infections.
A retrospective review of hospital records of patients admitted with a CIED-related infection was conducted in 4 academic hospitals in Houston, Tex, between 2002 and 2009. Of the 504 identified patients with CIED-related infection, 80 (16%) had a nonstaphylococcal infection and were the focus of this study. The mean duration of CIED placement before infection was 109+/-27 weeks, whereas 44% had their device previously manipulated within a mean of 29.5+/-6 weeks. The mean duration of clinical symptoms before admission was 48+/-12.8 days. Furthermore, 13 patients (16%) presented with CIED-related endocarditis. Although not described in prior reports, we identified 3 definite and 2 suspected cases of secondary Gram-negative bacteria seeding of the CIED. Inappropriate antimicrobial coverage was provided in approximately 50% of the cases with a mean period of 2.1 days. The overall mortality rate was 4%.
Nonstaphylococcal CIED-related infections are prevalent and diverse with a relatively low virulence and mortality rate. Because nonstaphylococcal organisms are capable of secondarily seeding the CIED, a high suspicion for CIED-related infection is warranted in patients with bloodstream infection. In patients with suspected CIED infection, adequate Gram-positive and Gram-negative antibacterial coverage should be administered until microbiological data become available.
随着心脏植入式电子设备（CIED）的使用不断增加，此类设备的感染数量也不成比例地增加。对于非葡萄球菌性 CIED 相关感染知之甚少，这类感染约占所有 CIED 感染的 10%至 30%。
在 2002 年至 2009 年间，在德克萨斯州休斯顿的 4 所学术医院对因 CIED 相关感染住院的患者的医院记录进行了回顾性分析。在确定的 504 例 CIED 相关感染患者中，有 80 例（16%）患有非葡萄球菌感染，是本研究的重点。感染前 CIED 放置的平均时间为 109+/-27 周，而 44%的患者在平均 29.5+/-6 周前对设备进行了操作。入院前临床症状的平均持续时间为 48+/-12.8 天。此外，13 例患者（16%）出现 CIED 相关心内膜炎。虽然在之前的报告中没有描述，但我们发现了 3 例明确的和 2 例疑似的 CIED 继发性革兰氏阴性细菌播种。大约 50%的病例提供了不适当的抗菌药物覆盖，平均持续时间为 2.1 天。总的死亡率为 4%。
非葡萄球菌性 CIED 相关感染普遍存在且多样化，其毒力和死亡率相对较低。由于非葡萄球菌能够继发性地播种 CIED，因此对于患有血流感染的患者，应高度怀疑 CIED 相关感染。对于疑似 CIED 感染的患者，应给予充分的革兰氏阳性和革兰氏阴性抗菌药物覆盖，直至获得微生物学数据。
