Rodriguez Yasser, Greenspon Arnold J, Sohail Muhammad R, Carrillo Roger G
Department of Cardiothoracic Surgery, University of Miami, Miami, FL, USA.
Pacing Clin Electrophysiol. 2012 Mar;35(3):269-74. doi: 10.1111/j.1540-8159.2011.03288.x. Epub 2011 Dec 8.
Infective endocarditis is the most serious manifestation of cardiac device infection and metastatic seeding of distant sites has been reported. However, the association between device-related endocarditis and spinal abscess has not been fully described.
We reviewed hospital records at three high-volume cardiovascular referral centers from January 2005 to October 2010. Device-related endocarditis was confirmed in all cases with positive blood cultures and transesophageal echocardiogram revealing lead and/or valvular vegetations. Six patients with spinal abscesses in association with device-related endocarditis were identified.
A total of 384 patients met the clinical criteria for device-related endocarditis. Among these, infection was complicated by spinal abscess formation in six (1.5%) cases. The mean age of patients was 69.3 ± 11.8 years (47-82 years). The predominant clinical manifestations in these six patients included a recent history of fever (six), malaise (four), and neurological or meningeal signs (five). Spinal abscesses were diagnosed by magnetic resonance imaging in two and computed tomography scans in four of the cases. The causative pathogens were methicillin-resistant Staphylococcus aureus (three), methicillin-sensitive S. aureus (one), coagulase-negative Staphylococci (two), and Enterococcus fecalis (one). All patients underwent complete device removal with no procedure-related complications. Two patients died in the hospital, two were discharged with permanent neurological deficits, and the remaining two recovered with no permanent neurologic sequelae.
Device-related endocarditis must be considered in patients who present with a spinal abscess and bacteremia. Early recognition of this scenario is imperative in order to avoid permanent neurological sequelae and patient mortality. Early imaging, appropriate parenteral antimicrobial therapy, and expedited removal of all cardiac hardware are pivotal for optimal management.
感染性心内膜炎是心脏装置感染最严重的表现形式，已有远处部位转移播散的报道。然而，装置相关性心内膜炎与脊柱脓肿之间的关联尚未得到充分描述。
我们回顾了2005年1月至2010年10月期间三家大型心血管转诊中心的医院记录。所有血培养阳性且经食管超声心动图显示导线和/或瓣膜赘生物的病例均确诊为装置相关性心内膜炎。我们确定了6例与装置相关性心内膜炎相关的脊柱脓肿患者。
共有384例患者符合装置相关性心内膜炎的临床标准。其中，6例（1.5%）感染并发脊柱脓肿形成。患者的平均年龄为69.3±11.8岁（47 - 82岁）。这6例患者的主要临床表现包括近期发热史（6例）、不适（4例）以及神经或脑膜体征（5例）。2例患者通过磁共振成像诊断出脊柱脓肿，4例通过计算机断层扫描诊断出。致病病原体为耐甲氧西林金黄色葡萄球菌（3例）、甲氧西林敏感金黄色葡萄球菌（1例）、凝固酶阴性葡萄球菌（2例）和粪肠球菌（1例）。所有患者均接受了完整的装置移除，无手术相关并发症。2例患者在医院死亡，2例出院时伴有永久性神经功能缺损，其余2例康复且无永久性神经后遗症。
对于出现脊柱脓肿和菌血症的患者，必须考虑装置相关性心内膜炎。尽早识别这种情况对于避免永久性神经后遗症和患者死亡至关重要。早期影像学检查、适当的肠外抗菌治疗以及迅速移除所有心脏硬件对于最佳治疗至关重要。
