Cardiac Arrhythmia Center, Washington, District of Columbia, USA.
Am J Cardiol. 2012 May 15;109(10):1466-71. doi: 10.1016/j.amjcard.2012.01.360. Epub 2012 Feb 21.
Cardiac device infections (CDIs) represent a serious complication after the implantation of pacemakers and defibrillators. In addition to antimicrobials, complete hardware removal, mostly with percutaneous lead extraction (PLE), is necessary to limit recurrences. However, CDI diagnosis is often difficult and is sometimes delayed, and scarce data exist on how the timing of PLE may affect clinical outcomes. In this study, the in-hospital outcomes of 52 consecutive patients with CDIs who underwent PLE were retrospectively analyze. Co-morbidities such as diabetes mellitus, congestive heart failure, renal insufficiency, and end-stage renal disease were highly prevalent in the study cohort. Patients were divided into group A (bacteremia or device endocarditis) and group B (localized pocket infection). In-hospital mortality was 29% in group A and 5% in group B (p = 0.02) and was due mostly to sepsis. Hospital stays were shorter in group B patients (5.7 vs 21.7 days, p <0.001). Presentation with hypotension was more commonly observed in group A patients and was associated with higher in-hospital mortality, whereas pocket findings correlated with better survival. Postoperative courses after PLE were uneventful in most patients, and no fatal complications were observed. PLE was performed significantly earlier in group B patients (hospitalization day 1.3 vs 7.6, p <0.001). PLE performed within 3 hospitalization days was associated with lower in-hospital mortality (p = 0.01). In conclusion, PLE performed within 3 days from admission is associated with shorter hospitalization and better survival. A timely diagnosis is crucial, particularly in the absence of local findings, because early treatment with PLE is likely to prevent the catastrophic outcomes of unrelenting CDIs.
心脏器械感染（CDI）是心脏起搏器和除颤器植入后的严重并发症。除了使用抗生素外，还需要完全去除硬件，主要通过经皮导线拔除术（PLE）来限制复发。然而，CDI 的诊断通常较为困难，有时还会出现延迟，并且关于 PLE 时机如何影响临床结果的数据很少。在这项研究中，回顾性分析了 52 例连续接受 PLE 治疗的 CDI 患者的住院期间结局。研究队列中存在多种合并症，如糖尿病、充血性心力衰竭、肾功能不全和终末期肾病。患者被分为 A 组（菌血症或器械心内膜炎）和 B 组（局部囊袋感染）。A 组的住院死亡率为 29%，B 组为 5%（p = 0.02），主要死因是败血症。B 组患者的住院时间更短（5.7 天与 21.7 天，p <0.001）。A 组患者更常出现低血压表现，与较高的住院死亡率相关，而囊袋表现与更好的生存相关。大多数患者在 PLE 后术后过程顺利，未观察到致命并发症。B 组患者的 PLE 明显更早进行（住院第 1.3 天与第 7.6 天，p <0.001）。在入院后 3 天内进行 PLE 与较低的住院死亡率相关（p = 0.01）。总之，入院后 3 天内进行 PLE 与较短的住院时间和更好的生存相关。及时诊断至关重要，特别是在没有局部发现的情况下，因为早期进行 PLE 治疗可能会预防持续 CDI 灾难性结局的发生。
