Division of Cardiology, Department of Internal Medicine, Azienda Ospedaliero-Universitaria San Giovanni Battista di Torino, University of Turin, Molinette, Corso A. M. Dogliotti, 14 10126 Torino, Italy.
Europace. 2013 Jan;15(1):89-100. doi: 10.1093/europace/eus240. Epub 2012 Sep 11.
Actual rates of lead vegetations (LVs) in cardiovascular device infections (CDI) are debated in this study. The aim of this study is to characterize prevalence and risk factors of LV in patients with CDI treated with lead extraction (LE).
Between 2003 and 2011, 293 leads were extracted from 136 patients (age 70.5 ± 14.5 years, 109 male) with infective indications: 39.2% chronic draining sinus, 20.9% pocket infections, and 28.8% systemic infections/sepsis. All patients underwent transesophageal echocardiography (TEE) before LE. Lead vegetation prevalence was 40.4%: 62.2% in systemic infection, but noteworthy in local infection/chronic draining sinus (21.9/36.4%). Younger age, renal disease, ad dialysis were associated with systemic infection. Fever after last intervention, revision, previous reparative procedure, infection at wound/device site and infection >6 months were associated with local infection/chronic draining sinus. Cardiac resynchronization therapy device, fever after last intervention, infection <6 months, renal disease, dialysis, abnormal chest X-ray, fever at admission, pulmonary symptoms, white blood cell (WBC) count, erythrocyte sedimentation rate, C-reactive protein increase and positive blood samples were related to LV. Risk of vegetations was reduced by antibiotic prophylaxis. Multivariate analysis indicated that renal failure and increased WBC count were related to LV.
Lead vegetations were frequently observed in patients with only local symptoms. Therefore, TEE should be mandatory in all patients undergoing LE for infective indications.
本研究旨在探讨心血管器械感染（CDI）中实际的赘生物（LV）发生率。本研究的目的是描述经心内膜引导的导线拔除术（LE）治疗 CDI 患者中 LV 的患病率和危险因素。
2003 年至 2011 年间，因感染指征接受 LE 的 136 例患者（年龄 70.5±14.5 岁，109 例男性）中有 293 根导线被拔除：39.2%为慢性窦道引流，20.9%为囊袋感染，28.8%为全身感染/败血症。所有患者在 LE 前均接受经食管超声心动图（TEE）检查。LV 的患病率为 40.4%：全身感染率为 62.2%，但在局部感染/慢性窦道引流中也值得关注（21.9%/36.4%）。年龄较小、肾脏疾病、透析与全身感染相关。上次干预后发热、翻修、先前修复术、感染部位/器械部位感染和感染>6 个月与局部感染/慢性窦道引流相关。心脏再同步治疗设备、上次干预后发热、感染<6 个月、肾脏疾病、透析、异常胸片、入院时发热、肺部症状、白细胞（WBC）计数、红细胞沉降率、C 反应蛋白升高和阳性血样与 LV 相关。抗生素预防可降低赘生物的风险。多变量分析表明，肾衰竭和白细胞计数增加与 LV 相关。
仅局部症状的患者中常观察到 LV。因此，对于因感染指征而行 LE 的所有患者，TEE 应作为常规检查。
