Harper Mariko W, Uslan Daniel Z, Greenspon Arnold J, Baddour Larry M, Carrillo Roger G, Danik Stephan B, Tolosana Jose M, Le Katherine, Miro Jose M, Naber Christoph K, Peacock James, Sohail Muhammad Rizwan, Vikram Holenarasipur R, Prutkin Jordan M
Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA.
Division of Infectious Diseases, Department of Medicine, UCLA, Los Angeles, California, USA.
Open Heart. 2018 Mar 30;5(1):e000681. doi: 10.1136/openhrt-2017-000681. eCollection 2018.
To explore differences in clinical manifestations and outcomes in those patients who develop infection after undergoing initial implantation versus reoperation.
We compared cases of cardiac implantable electronic device (CIED) infection based on initial implantation versus reoperation from 11 centres.
There were 432 patients with CIED infection, 178 occurring after initial device placement and 254 after repeat reoperation. No differences were seen in age, sex or device type. Those with infection after initial implant had a higher Charlson Comorbidity Score (median 3 (IQR 2-6) vs 2 (IQR 1-4), p<0.001), shorter time since last procedure (median 8.9 months (IQR 0.9-33.3) vs 19.5 months (IQR 1.1-62.9), p<0.0001) and fewer leads (2.0±0.6vs 2.5±0.9, p<0.001). Pocket infections were more likely to occur after a reoperation (70.1%vs48.9%, p<0.001) and coagulase negative staphylococci (CoNS) was the most frequently isolated organism in this group (p=0.029). In contrast, initial implant infections were more likely to present with higher white cell count (10.5±5.1 g/dL vs 9.5±5.4 g/dL, p=0.025), metastatic foci of infection (16.9%vs8.7%, p=0.016) and sepsis (30.9%vs19.3%, p=0.006). There were no differences in in-hospital (7.9%vs5.2%, p=0.31) or 6-month mortality (21.9%vs14.0%, p=0.056).
CIED infections after initial device implant occur earlier, more aggressively, and often due to . In contrast, CIED infections after reoperation occur later, are due to CoNS, and have more indolent manifestations with primary localisation to the pocket.
探讨初次植入后发生感染与再次手术患者的临床表现及预后差异。
我们比较了来自11个中心的初次植入与再次手术的心脏植入式电子设备（CIED）感染病例。
共有432例CIED感染患者，178例发生在初次植入设备后，254例发生在再次手术后。在年龄、性别或设备类型方面未见差异。初次植入后发生感染的患者Charlson合并症评分更高（中位数3（四分位间距2 - 6）对中位数2（四分位间距1 - 4），p<0.001），距上次手术时间更短（中位数8.9个月（四分位间距0.9 - 33.3）对19.5个月（四分位间距1.1 - 62.9），p<0.0001），且导线数量更少（2.0±0.6对2.5±0.9，p<0.001）。再次手术后更易发生囊袋感染（70.1%对48.9%，p<0.001），凝固酶阴性葡萄球菌（CoNS）是该组中最常分离出的病原体（p = 0.029）。相比之下，初次植入感染更易出现白细胞计数升高（10.5±5.1g/dL对9.5±5.4g/dL，p = 0.0
