Obeid Karam M, Szpunar Susan, Khatib Riad
Department of Infectious Diseases, St. John Hospital and Medical Center, Detroit, Michigan, USA.
Pacing Clin Electrophysiol. 2012 Aug;35(8):961-5. doi: 10.1111/j.1540-8159.2012.03438.x. Epub 2012 Jun 9.
The use of cardiovascular implantable electronic devices (CIEDs) is increasing. Staphylococcus aureus bacteremia (SAB) poses a risk for hematogenous seeding of the device. Our aim is to identify risk factors associated with secondary CIED infection, due to hematogenous seeding, during SAB from an unrelated primary focus.
All patients with SAB and CIED were screened. Patients with SAB due to a primary source unrelated to the CIED were included. Patients were classified into cases if CIED infection was documented and controls without CIED infection during a minimum of 12 weeks follow-up. A retrospective review of patients' charts was done.
Thirty patients with CIED and SAB from an unrelated focus were identified. CIED infection developed in 11 patients (36.7%). No significant differences were noted between cases and controls in the source, time-to-therapy, and time-to-intervene but infected devices were more likely to be implantable cardioverter-defibrillators (ICD) versus permanent pacemakers (PPMs) (9/11 [81.8%] vs 2/11 [18.2%] respectively, crude odds ratio 12.6, 95% confidence interval 10.8-14.4; P = 0.003).
Hematogenous seeding of a CIED during SAB from an unrelated focus is not uncommon. The risk factors for CIED seeding are unknown but ICD devices seem to be at greater risk when compared to PPM. The reasons are not yet clear. Larger studies are needed to better define risk factors and design preventive measures.
心血管植入式电子设备（CIEDs）的使用正在增加。金黄色葡萄球菌菌血症（SAB）会导致设备血行播散。我们的目的是确定在源自无关原发灶的SAB期间，因血行播散导致继发性CIED感染的相关危险因素。
对所有患有SAB和CIED的患者进行筛查。纳入原发性感染源与CIED无关的SAB患者。在至少12周的随访期间，记录有CIED感染的患者被分类为病例组，无CIED感染的患者为对照组。对患者病历进行回顾性分析。
确定了30例患有CIED且感染源无关的SAB患者。11例患者（36.7%）发生了CIED感染。病例组和对照组在感染源、治疗时间和干预时间方面无显著差异，但感染的设备更可能是植入式心律转复除颤器（ICD）而非永久性起搏器（PPM）（分别为9/11 [81.8%] 对2/11 [18.2%]，粗比值比12.6，95%置信区间10.8 - 14.4；P = 0.003）。
在源自无关原发灶的SAB期间，CIED血行播散并不少见。CIED播散的危险因素尚不清楚，但与PPM相比，ICD设备似乎风险更大。原因尚不清楚。需要更大规模的研究来更好地确定危险因素并设计预防措施。
