De Maria Elia, Diemberger Igor, Vassallo Pier L, Pastore Monica, Giannotti Federica, Ronconi Cinzia, Romandini Andrea, Biffi Mauro, Martignani Cristian, Ziacchi Matteo, Bonfatti Federica, Tumietto Fabio, Viale Pierluigi, Boriani Giuseppe
aCardiology Unit, 'Ramazzini Hospital', Carpi, Modena bInstitute of Cardiology, University of Bologna cCardiology Unit, 'Santa Maria della Scaletta Hospital', Imola, Bologna dCardiology Unit, 'San Secondo Hospital', Fidenza, Parma eCardiology Unit, Hospital of Ravenna, Ravenna fCardiology Unit, 'Infermi Hospital', Rimini gInstitute of Cardiology, University of Ancona, Ancona hClinic of Infective Diseases, University of Bologna, Bologna, Italy *Elia De Maria and Igor Diemberger contributed equally to the writing of the article.
J Cardiovasc Med (Hagerstown). 2014 Jul;15(7):554-64. doi: 10.2459/JCM.0000000000000008.
The increase in incidence/prevalence of infections of implantable pacemakers and defibrillators (implantable cardioverter defibrillator, ICD) is outweighing that of the implanting procedures, mainly favored by the changes in patient profile. Despite the high impact on patient's outcome and related costs for healthcare systems, we lack specific evidence on the preventive measures with the exception of antibiotic prophylaxis. The aim of this study is to focus on common approaches to pacemaker/ICD implantation to identify the practical preventive strategies and choices that can (potentially) impact on the occurrence of this feared complication. After a brief introduction on clinical presentation, pathogenesis, and risk factors, we will present the results from a survey on the preventive strategies adopted by different operators from the 25 centers of the Emilia Romagna region in the northern Italy (4.4 million inhabitants). These data will provide the basis for reviewing available literature on this topic and identifying the gray areas. The last part of the article will cover the available evidence about pacemaker/ICD implantation, focusing on prophylaxis of pacemaker/ICD infection as a 'continuum' starting before the surgical procedure (from indications to patient preparation), which follows during (operator, room, and techniques) and after the procedure (patient and device follow-up). We will conclude by evaluating the relationship between adherence to the available evidence and the volume of procedures of the implanting centers or operators' experience according to the results of our survey.
植入式起搏器和除颤器（植入式心律转复除颤器，ICD）感染的发病率/患病率增长超过了植入手术的增长，这主要得益于患者群体的变化。尽管对患者的预后以及医疗系统的相关成本影响巨大，但除了抗生素预防外，我们缺乏关于预防措施的具体证据。本研究的目的是聚焦于起搏器/ICD植入的常见方法，以确定可能（潜在地）影响这种可怕并发症发生的实际预防策略和选择。在简要介绍临床表现、发病机制和危险因素后，我们将展示对意大利北部艾米利亚 - 罗马涅地区25个中心（440万居民）不同操作人员所采用预防策略的调查结果。这些数据将为回顾该主题的现有文献并确定灰色区域提供依据。文章的最后一部分将涵盖关于起搏器/ICD植入的现有证据，重点是将起搏器/ICD感染的预防作为一个从手术前（从适应症到患者准备）开始、贯穿手术过程（操作人员、手术室和技术）以及手术后（患者和设备随访）的“连续过程”。我们将根据调查结果评估遵循现有证据与植入中心的手术量或操作人员经验之间的关系来得出结论。
