Pol Arch Intern Med. 2017 Sep 29;127(9):597-607. doi: 10.20452/pamw.4065. Epub 2017 Jul 19.
INTRODUCTION Cardiac implantable electronic device (CIED) infections still constitute a significant challenge. The knowledge of risk factors for CIED infections is crucial for preventing infections and reducing mortality rates. OBJECTIVES The aim of this study was to assess the risk factors and long-term survival of patients with CIED infections. PATIENTS AND METHODS We analyzed the clinical data of 1837 patients (including 750 [40.9%] patients with CIED infections), who underwent transvenous lead extraction at a single institution between 2006 and 2015. We compared the clinical and procedure-related factors for all types of CIED infections: isolated pocket infection (IPI), isolated lead-related infective endocarditis (ILRIE), and lead-related infective endocarditis with coexisting pocket infection (LRIE + PI). We also analyzed long-term survival rates. RESULTS The development of IPI and LRIE + PI depended mainly on age, male sex, number of leads, presence of implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy defibrillator (CRT-‑D), and the number of previous procedures. The factors that determined ILRIE included chronic kidney disease (CKD), ICD/CRT-D, lead loops, and intracardiac lead abrasion. Chronic anticoagulation and antiplatelet treatment protected against the development of infection. Long-term survival was significantly related to age, heart failure, diabetes mellitus, CKD, malignancy, and chronic atrial fibrillation. CONCLUSIONS The development of all types of CIED infection was associated mainly with procedure-related factors, while long-‑term mortality was dependent on clinical factors. The dissimilarity of factors affecting the development of IPI and ILRIE confirms that there are 2 variants of CIED infection. The protective effects of chronic anticoagulation and antiplatelet treatment should prompt us to consider such therapy in the prevention of CIED infection.
引言
心脏植入式电子设备（CIED）感染仍然是一个重大挑战。了解 CIED 感染的危险因素对于预防感染和降低死亡率至关重要。
目的
本研究旨在评估 CIED 感染患者的危险因素和长期生存率。
患者和方法
我们分析了 2006 年至 2015 年期间在一家机构接受经静脉导线拔除术的 1837 名患者（包括 750 名[40.9%] CIED 感染患者）的临床数据。我们比较了所有类型 CIED 感染（单纯囊袋感染[IPI]、单纯导线相关感染性心内膜炎[ILRIE]和伴有共存囊袋感染的导线相关感染性心内膜炎[LRIE+PI]）的临床和手术相关因素。我们还分析了长期生存率。
结果
IPI 和 LRIE+PI 的发展主要取决于年龄、男性、导线数量、植入式心脏复律除颤器（ICD）或心脏再同步治疗除颤器（CRT-D）的存在以及之前的手术次数。ILRIE 的决定因素包括慢性肾脏病（CKD）、ICD/CRT-D、导线环和心内导线磨损。慢性抗凝和抗血小板治疗可预防感染的发生。长期生存与年龄、心力衰竭、糖尿病、CKD、恶性肿瘤和慢性心房颤动显著相关。
结论
所有类型的 CIED 感染的发展主要与手术相关因素有关，而长期死亡率则取决于临床因素。影响 IPI 和 ILRIE 发展的因素不同，证实了 CIED 感染有 2 种类型。慢性抗凝和抗血小板治疗的保护作用促使我们考虑在预防 CIED 感染中应用这种治疗方法。
