Rodriguez David J, Afzal Aisha, Evonich Rudolph, Haines David E
Department of Cardiovascular Medicine, Oakland University William Beaumont School of Medicine, Beaumont Health System Royal Oak, MI, USA.
Am J Cardiovasc Dis. 2012;2(2):116-22. Epub 2012 May 15.
Pacemaker and defibrillator infections are an uncommon, but catastrophic complication of device implantation. The present study examined the prevalence of device-related infections, the patterns of antibiotic resistance, and the presence of methicillin resistant staphylococcus aureus (MRSA) nares colonization in device implant recipients.
Two protocols were employed using a retrospective and a prospective analysis. A retrospective chart review of 218 patients with suspected device infection from 1/2000 to 1/2011 was performed. Demographics, infection rates, and patterns of antibiotic resistance were compared. The prospective analysis enrolled one hundred eighty two patients undergoing device implantations or generator replacements. The nares were swabbed and analyzed for the presence of staphylococcus aureus, and tested for methicillin sensitivity.
Over a period of ten years, 12,771 device implants/generator changes/system revisions were performed, with an infection rate of 1.2%. Methicillin resistance (MR) was identified in 98/218 (44.9%) of patients. Those with MR infection had more diabetes and cardiomyopathy. There was no significant increase in methicillin resistance over time (p=0.30). Our prospective analysis included 110 men. A total of 32 patients (17.6%) had positive cultures for SA: 6.6% with MRSA. Patients positive for MRSA nares colonization had a statistically significant greater length of hospital stay 8.5 days (mean) versus 4.4 days (P=0.049).
Methicillin resistant organisms appear to be emerging and persistent pathogens in device implants. The screening of MRSA colonization may identify new populations at risk. Further studies and analysis are needed to determine the cost effectiveness of a screening protocol.
起搏器和除颤器感染是设备植入术后一种不常见但后果严重的并发症。本研究调查了设备相关感染的发生率、抗生素耐药模式以及设备植入受者中耐甲氧西林金黄色葡萄球菌（MRSA）鼻腔定植情况。
采用回顾性和前瞻性分析两种方案。对2000年1月至2011年1月期间218例疑似设备感染患者的病历进行回顾性分析。比较人口统计学、感染率和抗生素耐药模式。前瞻性分析纳入了182例接受设备植入或发生器更换的患者。采集鼻腔拭子分析金黄色葡萄球菌的存在情况，并检测对甲氧西林的敏感性。
在十年期间，共进行了12771次设备植入/发生器更换/系统修订，感染率为1.2%。在218例患者中有98例（44.9%）检测到耐甲氧西林（MR）。MR感染患者患有更多糖尿病和心肌病。随着时间推移，耐甲氧西林情况无显著增加（p=0.30）。我们的前瞻性分析纳入了110名男性。共有32例患者（17.6%）SA培养阳性：6.6%为MRSA。鼻腔MRSA定植阳性患者的住院时间在统计学上显著更长，平均为8.5天，而其他患者为4.4天（P=0.049）。
耐甲氧西林微生物似乎是设备植入中的新兴和持续存在的病原体。对MRSA定植进行筛查可能识别出新的高危人群。需要进一步研究和分析以确定筛查方案的成本效益。
