Keeley Alexander James, Hammersley Daniel, Dissanayake Madhava
Department of Cardiology, Western Sussex Hospitals NHS Trust, Worthing, UK.
BMJ Case Rep. 2017 Jun 20;2017:bcr-2017-220258. doi: 10.1136/bcr-2017-220258.
We present a successful conservative management strategy for a frail elderly patient with a cardiac resynchronisation pacemaker who presented with evidence of an pacemaker pocket infection. A device washout and debridement procedure was performed, with reburial of the device in a new prepectoral pocket and creation of a closed-loop continuous antibiotic infusion into the infected pacemaker pocket. This was followed by a 6-week course of ambulatory intravenous antibiotic therapy. This conservative management strategy avoided the need for a more invasive and high-risk full device extraction, which the patient clearly stated he did not wish to have. Up-to-date consensus management guidelines recommend extraction of the entire implanted system in this situation; however, in this case we demonstrate an alternative conservative management option, which may be suitable for frail elderly and comorbid patients or for patients who decline device extraction.
我们为一名植入心脏再同步起搏器的体弱老年患者制定了一种成功的保守治疗策略，该患者出现了起搏器囊袋感染的迹象。我们进行了设备冲洗和清创手术，将设备重新埋入新的胸前囊袋，并在感染的起搏器囊袋中建立闭环持续抗生素输注。随后进行了为期6周的门诊静脉抗生素治疗。这种保守治疗策略避免了进行更具侵入性和高风险的完全设备取出，患者明确表示他不希望进行这种手术。最新的共识管理指南建议在这种情况下取出整个植入系统；然而，在这个案例中，我们展示了一种替代的保守治疗方案，该方案可能适用于体弱的老年和合并症患者或拒绝取出设备的患者。
