Esquer Garrigos Zerelda, George Merit P, Farid Saira, Abu Saleh Omar M, Vijayvargiya Prakhar, Mahmood Maryam, Friedman Paul A, Steckelberg James M, DeSimone Daniel C, Wilson Walter R, Baddour Larry M, Sohail M Rizwan
Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
Pacing Clin Electrophysiol. 2018 May 31. doi: 10.1111/pace.13397.
Culture-negative (CN) cardiovascular implantable electronic device (CIED) infections represent a significant management challenge for clinicians with no specific guidelines addressing this subgroup of patients. The aim of the current investigation is to report our institutional experience of CN CIED infections and propose a systematic approach to diagnostic evaluation and management of these complicated cases based on our observations.
We retrospectively screened all CIED infection cases at Mayo Clinic from 2005 through 2017. Using standardized criteria to define significant microbial growth, all patients with positive blood or pocket/device cultures were excluded.
A total of 835 cases of CIED infection were screened, and of these, 47 (6%) met CN-CIED infection criteria. Majority of patients (77%) in this cohort had received antimicrobial therapy prior to device cultures with a median duration of 8 days. The most common presentation was device pocket infection (81%). All patients underwent device removal. Route of antibiotics was switched from oral to parenteral and spectrum of activity expanded from initial therapy in 23% of patients despite negative cultures. Majority of patients (80%) were dismissed on parenteral therapy. Adverse events attributed to intravenous antibiotic therapy were documented in 63% of the cases. No recurrence was reported and 6-month survival was 94.8%.
Pocket and device cultures in suspected CIED infections may be negative due to preextraction oral antibiotics. However, frequently these patients are managed with broad-spectrum parenteral therapy postextraction.
培养阴性（CN）的心血管植入式电子设备（CIED）感染给临床医生带来了重大的管理挑战，目前尚无针对这类患者亚组的具体指南。本研究的目的是报告我们机构对CN CIED感染的经验，并根据我们的观察结果提出一种对这些复杂病例进行诊断评估和管理的系统方法。
我们回顾性筛查了2005年至2017年梅奥诊所的所有CIED感染病例。使用标准化标准定义显著的微生物生长，排除所有血培养或囊袋/设备培养阳性的患者。
共筛查了835例CIED感染病例，其中47例（6%）符合CN-CIED感染标准。该队列中的大多数患者（77%）在进行设备培养之前接受了抗菌治疗，中位持续时间为8天。最常见的表现是设备囊袋感染（81%）。所有患者均接受了设备移除。23%的患者尽管培养结果为阴性，但抗生素给药途径从口服改为胃肠外给药，抗菌谱也从初始治疗时扩大。大多数患者（80%）在接受胃肠外治疗后出院。63%的病例记录了与静脉抗生素治疗相关的不良事件。未报告复发情况，6个月生存率为94.8%。
疑似CIED感染患者的囊袋和设备培养可能因提取前口服抗生素而呈阴性。然而，这些患者术后通常接受广谱胃肠外治疗。
