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一名免疫功能低下患者发生心脏植入式设备感染。

A cardiac implantable device infection by in an immunocompromized patient.

作者信息

Adjodah Chandra, D'Ivernois Chistophe, Leyssene David, Berneau Jean-Baptiste, Hemery Yann

机构信息

Infectious and Tropical Diseases Department, Amiens University Hospital , Amiens , France.

Department of Cardiovascular Diseases, Basque Coast Hospital Centre , Bayonne , France.

出版信息

JMM Case Rep. 2017 Feb 28;4(2):e005080. doi: 10.1099/jmmcr.0.005080. eCollection 2017 Feb.

Abstract

Infection of cardiac implantable electronic devices is a severe condition associated with high mortality, particularly in patients who are dependent upon heart-pacing devices. are found in 70 % of reported cases. We report the case of a cardiac-pacemaker infection in a 79-year-old man, cumulating a history of rheumatoid arthritis treated by corticosteroids and methotrexate by a recently identified micro-organism: . He presented local signs of infection on his VVI pacemaker implantation site and underwent urgent pocket device replacement under cefamandole antibioprophylaxis. On incision thick pus oozed out. It was necessary to perform a complete hardware extraction comprising the pulse generator and the ancient lead. Pus was inoculated into aerobic and anaerobic culture vials and Gram staining unveiled Gram-negative rods. Microbiology analysis identified the organism as A new pacing device was inserted on the contrlateral pectoral region. Ciprofloxacin enabled full recovery. A literature review concerning this pathogen revealed that it is involved in severe infections such as bloodstream infections, peritonitis, cellulitis, pneumonia and lung abscesses, and urinary tract infections. In these case reports, underlying co-morbidities were identified such as solid active neoplasia, recent chemotherapy, corticosteroids, solid-organ-recipient patients and recent open surgery. is a serious emerging pathogen and contributes to the burden of various infectious conditions. Its pathogenicity and occurrence should be known by clinicians and a high level of awareness is necessary to precisely identify it provide the correct antibiotic regimen.

摘要

心脏植入式电子设备感染是一种严重疾病,与高死亡率相关,尤其是在依赖心脏起搏器的患者中。在70%的报告病例中发现了(此处原文缺失相关内容)。我们报告了一例79岁男性的心脏起搏器感染病例,该患者有类风湿关节炎病史,曾接受皮质类固醇和甲氨蝶呤治疗,此次感染由一种最近发现的微生物(此处原文缺失微生物名称)引起。他的VVI起搏器植入部位出现局部感染迹象,并在头孢孟多预防性抗生素治疗下紧急进行了起搏器囊袋更换。切开后有浓稠脓液渗出。有必要进行包括脉冲发生器和旧电极在内的完整硬件取出。将脓液接种到需氧和厌氧培养瓶中,革兰氏染色显示为革兰氏阴性杆菌。微生物学分析确定该微生物为(此处原文缺失微生物名称)。在对侧胸壁区域插入了一个新的起搏装置。环丙沙星使患者完全康复。一项关于这种病原体的文献综述显示,它与严重感染有关,如血流感染、腹膜炎、蜂窝织炎、肺炎和肺脓肿以及尿路感染。在这些病例报告中,发现了一些潜在的合并症,如实体活动性肿瘤、近期化疗、皮质类固醇、实体器官移植受者患者和近期的开放性手术。(此处原文缺失微生物名称)是一种严重的新兴病原体,加重了各种感染性疾病的负担。临床医生应该了解它的致病性和发生率,并且需要高度警惕以准确识别它并提供正确的抗生素治疗方案。

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本文引用的文献

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Raoultella planticola bacteraemia secondary to gastroenteritis.植物杆菌菌血症继发于肠胃炎。
Clin Microbiol Infect. 2013 May;19(5):E236-7. doi: 10.1111/1469-0691.12102.
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Microbiology of cardiac implantable electronic device infections.心脏植入式电子设备感染的微生物学。
Europace. 2012 Sep;14(9):1334-9. doi: 10.1093/europace/eus044. Epub 2012 Mar 7.
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Cholangitis with septic shock caused by Raoultella planticola.由产酸克雷伯菌引起的胆管炎合并感染性休克。
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Eur J Intern Med. 2007 Oct;18(6):484-8. doi: 10.1016/j.ejim.2007.02.015. Epub 2007 Jul 20.
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Risk factor analysis of permanent pacemaker infection.永久性起搏器感染的危险因素分析
Clin Infect Dis. 2007 Jul 15;45(2):166-73. doi: 10.1086/518889. Epub 2007 Jun 6.

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