Saeed Omar, Gupta Anupam, Gross Jay N, Palma Eugen C
Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
Pacing Clin Electrophysiol. 2014 Aug;37(8):963-8. doi: 10.1111/pace.12407. Epub 2014 Apr 26.
Patients who develop a cardiovascular implantable electronic device (CIED) infection requiring extraction may have risk factors that make them prone to developing another infection of the reimplanted CIED. However, the rate of a second infection requiring repeat extraction in such patients is unknown and may have important clinical implications.
We retrospectively reviewed all patients at our institution from January 2001 to October 2012 who underwent a CIED extraction for an infection and then required reimplantation. We then reviewed the incidence of a repeat extraction due to a second infection. Clinical and device parameters at the time of the second infection were retrieved.
There were 168 patients who underwent a CIED extraction because of infection and were subsequently reimplanted. The median time to reimplantation was 3 [1(st) quartile: 1, 3(rd) quartile: 10] days. After a mean follow-up of 4.4 ± 2.7 years, nine (5.4%) patients underwent a repeat CIED extraction due to a second infection. Six repeat extractions (67%) occurred in the first year, leading to an event rate of 3.9% within 1 year of reimplantation. Patients with a second infection requiring a repeat CIED extraction were younger (57 ± 20 vs 68 ± 16, P = 0.046). Pocket infection was the most common presentation of a second infection, occurring in eight of the nine patients.
The rate of a second infection leading to a CIED repeat extraction is elevated within the first year after reimplantation. To determine predictors of recurring infection, analysis of a larger multicenter series is warranted.
因感染而需要取出心血管植入式电子设备（CIED）的患者可能存在一些风险因素，使他们易于再次发生重新植入的CIED感染。然而，这类患者中因再次感染而需要再次取出设备的发生率尚不清楚，且可能具有重要的临床意义。
我们回顾性分析了2001年1月至2012年10月在我院因感染而接受CIED取出并随后需要重新植入的所有患者。然后我们回顾了因再次感染而再次取出设备的发生率。获取了第二次感染时的临床和设备参数。
共有168例患者因感染而接受了CIED取出，随后进行了重新植入。重新植入的中位时间为3天[第一四分位数：1天，第三四分位数：10天]。平均随访4.4±2.7年后，9例（5.4%）患者因再次感染而接受了再次CIED取出。6例（67%）再次取出发生在第一年，导致重新植入后1年内的事件发生率为3.9%。因再次感染而需要再次取出CIED的患者更年轻（57±20岁对68±16岁，P = 0.046）。囊袋感染是再次感染最常见的表现，9例患者中有8例出现。
重新植入后第一年内，因再次感染导致CIED再次取出的发生率升高。为了确定复发性感染的预测因素，有必要对更大规模的多中心系列进行分析。
