Division of Cardiovascular Diseases and Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minn, USA.
Circ Arrhythm Electrophysiol. 2010 Dec;3(6):639-45. doi: 10.1161/CIRCEP.110.957514. Epub 2010 Sep 18.
Infection is a serious complication of cardiovascular implantable electronic device (CIED) placement and requires device removal for attempted cure.
We studied the rate, risk factors, and outcomes of CIED infection in 74 consecutive patients with bacteremia caused by Gram-positive cocci (GPC) other than Staphylococcus aureus between 2001 and 2007. CIED infection was defined as the presence of signs of infection at the generator site, lead vegetations seen on echocardiography, or microbiological growth from device cultures. Twenty-two (30%) of 74 patients with non-S aureus GPC bacteremia had CIED infections. Coagulase-negative staphylococci (CoNS) accounted for 73% of CIED infections. The rate of CIED infection in patients with CoNS bacteremia was almost 2-fold that of non-CoNS GPC bacteremia (36% versus 20%, P = 0.13). The number of leads, the presence of abandoned leads, and prior generator replacement were associated with CIED infection. Among 33 patients without identifiable CIED infection at initial evaluation who did not undergo device removal, 5 (15%) had relapsing bacteremia within 12 weeks of completing antibiotic therapy. CoNS accounted for all relapses, and none had evidence of CIED infection at relapse.
Patients with a CIED and bacteremia caused by GPC other than S aureus frequently had evidence of underlying CIED infection on clinical evaluation that included transesophageal echocardiography. This was particularly true among those with CoNS bacteremia. No evidence of underlying CIED infections was identified in the subgroup of patients who did not have manifestations of CIED infection on initial evaluation but subsequently had relapsing bacteremia caused by CoNS.
感染是心血管植入式电子设备（CIED）放置的严重并发症，需要移除设备以尝试治愈。
我们研究了 2001 年至 2007 年间 74 例由金黄色葡萄球菌以外的革兰阳性球菌（GPC）引起的菌血症患者中 CIED 感染的发生率、危险因素和结局。CIED 感染定义为发生器部位存在感染迹象、超声心动图上可见导丝植被或设备培养物有微生物生长。74 例非金黄色葡萄球菌 GPC 菌血症患者中，有 22 例（30%）发生 CIED 感染。凝固酶阴性葡萄球菌（CoNS）占 CIED 感染的 73%。CoNS 菌血症患者的 CIED 感染率几乎是无 CoNS GPC 菌血症患者的两倍（36%比 20%，P=0.13）。导丝数量、废弃导丝的存在以及先前的发生器更换与 CIED 感染有关。在最初评估时未发现明确的 CIED 感染且未进行设备移除的 33 例患者中，有 5 例（15%）在完成抗生素治疗后 12 周内出现复发性菌血症。CoNS 是所有复发性感染的原因，且在复发时均无 CIED 感染的证据。
患有 CIED 和由金黄色葡萄球菌以外的 GPC 引起的菌血症的患者，在包括经食管超声心动图在内的临床评估中通常有潜在 CIED 感染的证据。这在 CoNS 菌血症患者中更为明显。在最初评估时没有表现出 CIED 感染迹象但随后因 CoNS 引起复发性菌血症的患者亚组中，没有发现潜在的 CIED 感染证据。
