Da Costa A, Kirkorian G, Chevalier P, Cerisier A, Chalvidan T, Obadia J F, Etienne J, Isaaz K, Touboul P
Service de cardiologie, hôpital cardiovasculaire et pneumologique Louis-Pradel, BP Lyon-Montchat, Lyon.
Arch Mal Coeur Vaiss. 1998 Jun;91(6):753-7.
Infectious complications of pacemaker implantation are not common but may be particularly severe. Localised wound infections at the site of implantation have been reported in 0.5% of cases in the most recent series with an average of about 2%. The incidence of septicaemia and infectious endocarditis is lower, about 0.5% of cases. The operator's experience, the duration of the procedure and repeat procedures are considered to be predisposing factors. The main cause of these infections is though to be local contamination during the implantation. The commonest causal organism is the staphylococcus (75 to 92%), the staphylococcus aureus being the cause of acute infections whereas the staphylococcus epidermis is associated with cases of secondary infection. The usual clinical presentation is infection at the site of the pacemaker but other forms such as abscess, endocarditis, rejection of the implanted material, septic emboli and septic phlebitis have been described. The diagnosis is confirmed by local and systemic biological investigations and by echocardiography (especially transoesophageal echocardiography) in cases of right heart endocarditis. There are two axes of treatment: bactericidal double antibiotherapy and surgical ablation of the infected material either percutaneously or by cardiotomy. Though controversial, and unsupported by scientific evidence, the role of systematic, preoperative, prophylactic antibiotic therapy in the prevention of these complications seems to be increasing.
起搏器植入的感染并发症并不常见，但可能特别严重。在最近的系列病例中，植入部位的局部伤口感染报告发生率为0.5%，平均约为2%。败血症和感染性心内膜炎的发生率较低，约为病例的0.5%。操作者的经验、手术持续时间和重复手术被认为是易感因素。这些感染的主要原因被认为是植入过程中的局部污染。最常见的致病微生物是葡萄球菌（75%至92%），金黄色葡萄球菌是急性感染的原因，而表皮葡萄球菌与继发感染病例有关。通常的临床表现是起搏器部位的感染，但也有其他形式，如脓肿、心内膜炎、植入材料排斥、脓毒性栓子和脓毒性静脉炎。通过局部和全身生物学检查以及在右心内膜炎病例中通过超声心动图（尤其是经食管超声心动图）来确诊。治疗有两个方向：杀菌性双联抗微生物治疗以及经皮或通过心脏切开术对感染材料进行手术切除。尽管存在争议且缺乏科学证据支持，但系统性术前预防性抗生素治疗在预防这些并发症中的作用似乎在增加。
