Da Costa A, Lelièvre H, Kirkorian G, Célard M, Chevalier P, Vandenesch F, Etienne J, Touboul P
Service de Cardiologie, Hôpital cardiovasculaire et pneumologique, Lyon, France.
Circulation. 1998 May 12;97(18):1791-5. doi: 10.1161/01.cir.97.18.1791.
Infection remains a severe complication after pacemaker implantation. The purpose of our prospective study was to evaluate the role of the local bacteriologic flora in its occurrence.
Specimens were collected at the site of implantation for culture from the skin and the pocket before and after insertion in a consecutive series of patients who underwent elective permanent pacemaker implantation. Microorganisms isolated both at the time of insertion and of any potentially infective complication were compared by using conventional speciation and ribotyping. There were 103 patients (67 men and 36 women) whose age ranged from 16 to 93 years (mean+/-SD, 67+/-15). At the time of pacemaker implantation, a total of 267 isolates were identified. The majority (85%) were staphylococci. During a mean follow-up of 16.5 months (range, 1 to 24), infection occurred in four patients (3.9%). In two of them, an isolate of Staphylococcus schleiferi was recognized by molecular method as identical to the one previously found in the pacemaker pocket. In one patient, Staphylococcus aureus, an organism that was absent at the time of pacemaker insertion, was isolated. In another patient, a Staphylococcus epidermidis was identified both at the time of pacemaker insertion and when erosion occurred; however, their antibiotic resistance profiles were different.
This study strongly supports the hypothesis that pacemaker-related infections are mainly due to local contamination during implantation. S schleiferi appears to play an underestimated role in infectious colonization of implanted biomaterials and should be regarded as an important opportunistic pathogen.
感染仍是起搏器植入术后的严重并发症。我们这项前瞻性研究的目的是评估局部细菌菌群在其发生过程中的作用。
在一系列接受择期永久性起搏器植入的患者中，于植入前及植入后从皮肤和囊袋植入部位采集标本进行培养。通过常规菌种鉴定和核糖分型对植入时及任何潜在感染性并发症时分离出的微生物进行比较。共有103例患者（67例男性和36例女性），年龄范围为16至93岁（平均±标准差，67±15）。在起搏器植入时，共鉴定出267株分离菌。大多数（85%）为葡萄球菌。在平均16.5个月（范围1至24个月）的随访期间，4例患者（3.9%）发生感染。其中2例，通过分子方法鉴定出施氏葡萄球菌分离株与先前在起搏器囊袋中发现的相同。1例患者分离出金黄色葡萄球菌，该菌在起搏器植入时并不存在。另1例患者，在起搏器植入时及发生侵蚀时均鉴定出表皮葡萄球菌；然而，它们的抗生素耐药谱不同。
本研究有力支持了起搏器相关感染主要源于植入过程中局部污染的假说。施氏葡萄球菌在植入生物材料的感染定植中似乎发挥了被低估的作用，应被视为一种重要的机会致病菌。
