Refaat Marwan, Zakka Patrick, Khoury Maurice, Chami Hassan, Mansour Shareef, Harbieh Bernard, Abi-Saleh Bernard, Bizri Abdul Rahman
Department of Internal Medicine, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon.
Department of Internal Medicine, Emory University Hospital, Atlanta, GA, USA.
Medicine (Baltimore). 2019 Apr;98(16):e14906. doi: 10.1097/MD.0000000000014906.
With increasing rates of device implantation, there is an increased recognition of device infection. We conducted a retrospective observational study in a tertiary care center in Lebanon, with data collected from medical records of patients presenting with cardiac implantable electronic device (CIED) infection from 2000 to 2017 with the purpose of identifying etiologies, risk factors and other parameters, and comparing them to available data from the rest of the world. We identified a total of 22 CIED infections. The most common microbial etiologies, including involvement in polymicrobial infection, were coagulase-negative staphylococci (45.5%) and Staphylococcus aureus (22.7%). Rare cases of Brucella melitensis, Sphingomonas paucimobilis, and Kytococcus schroeteri device infection were seen. Heart failure was seen in 77.3% of patients, hypertension in 68.2%, and chronic kidney disease in 50%. Skin changes were the most common presenting symptoms (86.4%). Antibiotics were given to all patients and all had their devices removed, with 36.4% undergoing new device implantation. This is the first study of CIED infections in Lebanon and the Middle East. Local epidemiology and occupational exposure must be considered while contemplating the microbial etiology of infection. Close monitoring after device implantation is important in preventing device infection that carries high risk of morbidity and mortality.
随着设备植入率的不断提高，人们对设备感染的认识也在增加。我们在黎巴嫩的一家三级医疗中心进行了一项回顾性观察研究，收集了2000年至2017年出现心脏植入式电子设备（CIED）感染的患者的病历数据，目的是确定病因、风险因素和其他参数，并将其与世界其他地区的现有数据进行比较。我们共确定了22例CIED感染。最常见的微生物病因，包括参与多微生物感染的情况，是凝固酶阴性葡萄球菌（45.5%）和金黄色葡萄球菌（22.7%）。还发现了罕见的布鲁氏菌、少动鞘氨醇单胞菌和施氏库克菌设备感染病例。77.3%的患者有心力衰竭，68.2%有高血压，50%有慢性肾病。皮肤变化是最常见的症状（86.4%）。所有患者均接受了抗生素治疗，所有患者的设备均被移除，36.4%的患者接受了新设备植入。这是黎巴嫩和中东地区关于CIED感染的第一项研究。在考虑感染的微生物病因时，必须考虑当地的流行病学和职业暴露情况。设备植入后密切监测对于预防具有高发病和死亡风险的设备感染很重要。
