Sohail Muhammad R, Hussain Salwa, Le Katherine Y, Dib Chadi, Lohse Christine M, Friedman Paul A, Hayes David L, Uslan Daniel Z, Wilson Walter R, Steckelberg James M, Baddour Larry M
Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
J Interv Card Electrophysiol. 2011 Aug;31(2):171-83. doi: 10.1007/s10840-010-9537-x. Epub 2011 Mar 2.
The infection rates of implantable cardioverter-defibrillators systems (ICDs) are higher than that of permanent pacemaker. Risk factors associated with ICD infection have not been characterized and are the subject of the current investigation.
All patients who had an ICD implanted at Mayo Clinic Rochester between 1991 and 2008 were retrospectively reviewed. Each case of ICD infection was matched with two non-infected controls. Cases of ICD infection were further stratified by early- (≤ 6 months) versus late-onset (>6 months) infection. Multivariable analysis was performed to identify significant risk factors for ICD infection.
Sixty-eight patients with ICD infection and 136 matched controls met the inclusion criteria. Thirty-five cases presented with early-onset infection and 33 had late-onset device infection. Staphylococcal species were the most common pathogens in both groups of patients. Patients with early-onset infection were more likely to present with generator pocket infection (p = 0.02). Patients with multiple comorbid conditions (high Charlson index) tended to have longer hospital stay during implantation admission (p = 0.009). In a multivariable logistic regression model, the presence of epicardial leads (odds ratio (OR) = 9.7, p = 0.03) and postoperative complications at the generator pocket (OR = 27.2, p < 0.001) were significant risk factors for early-onset ICD infection, whereas longer duration of hospitalization at the time of implantation (2 days versus 1 day: OR = 33.1, p < 0.001; ≥ 3 days versus 1 day: OR = 49.0, p < 0.001) and chronic obstructive pulmonary disease (OR = 9.8, p = 0.02) were associated with late-onset infections.
Our study findings suggest that risk factors associated with early- and late-onset ICD infection are different. While circumstances that may increase the chances of pocket contamination in the perioperative period are more likely to be associated with early-onset ICD infection, overall poor health of the host may increase the likelihood of late-onset ICD infection. These factors should be considered when developing strategies to minimize risk of device infection.
植入式心脏复律除颤器系统（ICD）的感染率高于永久性起搏器。与ICD感染相关的危险因素尚未明确，是当前研究的主题。
对1991年至2008年在梅奥诊所罗切斯特分院植入ICD的所有患者进行回顾性研究。每例ICD感染患者与两名未感染的对照进行匹配。ICD感染病例进一步分为早期（≤6个月）与晚期（>6个月）感染。进行多变量分析以确定ICD感染的显著危险因素。
68例ICD感染患者和136例匹配对照符合纳入标准。35例为早期感染，33例为晚期器械感染。葡萄球菌是两组患者中最常见的病原体。早期感染患者更易出现发生器囊袋感染（p = 0.02）。合并多种疾病（Charlson指数高）的患者在植入住院期间住院时间往往更长（p = 0.009）。在多变量逻辑回归模型中，心外膜导线的存在（比值比（OR）= 9.7，p = 0.03）和发生器囊袋术后并发症（OR = 27.2，p < 0.001）是早期ICD感染的显著危险因素，而植入时住院时间延长（2天对1天：OR = 33.1，p < 0.001；≥3天对1天：OR = 49.0，p < 0.001）和慢性阻塞性肺疾病（OR = 9.8，p = 0.02）与晚期感染相关。
我们的研究结果表明，与早期和晚期ICD感染相关的危险因素不同。围手术期可能增加囊袋污染机会的情况更可能与早期ICD感染相关，而宿主整体健康状况差可能增加晚期ICD感染的可能性。在制定将器械感染风险降至最低的策略时应考虑这些因素。
