Boyle Thomas A, Uslan Daniel Z, Prutkin Jordan M, Greenspon Arnold J, Baddour Larry M, Danik Stephan B, Tolosana Jose M, Le Katherine, Miro Jose M, Peacock James, Sohail Muhammad R, Vikram Holenarasipur R, Carrillo Roger G
From the Department of Surgery, Division of Cardiothoracic Surgery, University of Miami, FL (T.A.B.); Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at University of California, Los Angeles (D.Z.U.); Department of Medicine, Division of Cardiology, University of Washington, Seattle (J.M.P.); Department of Medicine, Division of Cardiology, Cardiac Electrophysiology Laboratory, Thomas Jefferson University Hospital, Philadelphia, PA (A.J.G.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic College of Medicine, Rochester, MN (L.M.B., K.L., M.R.S.); Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Boston (S.B.D.); Department of Medicine, Division of Infectious Diseases, Hospital Clinic, IDIBAPS, University of Barcelona, Spain (J.M.T., J.M.M.); Department of Medicine, Division of Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC (J.P.); and Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Phoenix, AZ (H.R.V.).
Circ Arrhythm Electrophysiol. 2017 Mar;10(3). doi: 10.1161/CIRCEP.116.004822.
Infection is a serious complication of cardiovascular-implantable electronic device implantation and necessitates removal of all hardware for optimal treatment. Strategies for reimplanting hardware after infection vary widely and have not previously been analyzed using a large, multicenter study.
The MEDIC (Multicenter Electrophysiologic Device Infection Cohort) prospectively enrolled subjects with cardiovascular-implantable electronic device infections at multiple institutions in the United States and abroad between 2009 and 2012. Reimplantation strategies were evaluated overall, and every patient who relapsed within 6 months was individually examined for clinical information that could help explain the negative outcome. Overall, 434 patients with cardiovascular-implantable electronic device infections were prospectively enrolled at participating centers. During the initial course of therapy, complete device removal was done in 381 patients (87.8%), and 220 of them (57.7%) were ultimately reimplanted with new devices. Overall, the median time between removal and reimplantation was 10 days, with an interquartile range of 6 to 19 days. Eleven of the 434 patients had another infection within 6 months, but only 4 of them were managed with cardiovascular-implantable electronic device removal and reimplantation during the initial infection. Thus, the repeat infection rate was low (1.8%) in those who were reimplanted. Patients who retained original hardware had a 11.3% repeat infection rate.
Our study findings confirm that a broad range of reimplant strategies are used in clinical practice. They suggest that it is safe to reimplant cardiac devices after extraction of previously infected hardware and that the risk of a second infection is low, regardless of reimplant timing.
感染是心血管植入式电子设备植入后的一种严重并发症，需要移除所有硬件以进行最佳治疗。感染后重新植入硬件的策略差异很大，此前尚未通过大型多中心研究进行分析。
MEDIC（多中心电生理设备感染队列研究）于2009年至2012年在美国和国外的多个机构前瞻性纳入了患有心血管植入式电子设备感染的受试者。总体评估了重新植入策略，并对每例在6个月内复发的患者单独检查可能有助于解释不良结局的临床信息。总体而言，434例患有心血管植入式电子设备感染的患者在参与中心进行了前瞻性登记。在初始治疗过程中，381例患者（87.8%）进行了完整的设备移除，其中220例（57.7%）最终重新植入了新设备。总体而言，移除与重新植入之间的中位时间为10天，四分位间距为6至19天。434例患者中有11例在6个月内再次感染，但其中只有4例在初始感染期间接受了心血管植入式电子设备移除和重新植入治疗。因此，重新植入患者的再次感染率较低（1.8%）。保留原有硬件的患者再次感染率为11.3%。
我们的研究结果证实临床实践中使用了广泛的重新植入策略。研究结果表明，在取出先前感染的硬件后重新植入心脏设备是安全的，且无论重新植入时间如何，二次感染的风险都较低。
