心脏植入电子装置感染的相关危险因素分析

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Abstract Objective: To determine the the incidence of infection in cardiovascular implantable electronic device (CIED) in our heart centre, and analyse the risk factors associated with infection. Methods: Thirteen years (2000-2012) of cases of CIED infection were analyzed retrospectively. The clinical presentation and base characteristics of these patients were analyzed, risk factors associated with infection were assessed. Results: 1 817 cases (male:female=1.4:1) were implanted cardiac electronic device [permanent pacemakers, cardiac resynchronization therapy (CRT) and implantable cardioverter defibrillator (ICD)]. 16 patients (male:female=3:1) occurred CIED infection, the incidence was 0.9%. Fifteen (93.8%) cases were identified as pacemaker pocket infection. Microorganisms were detected in 68.8% cases, Of which 90.9% was coagulase-negative staphylococci. Significant risk factors included implantation of ICD/CRT-D (P=0.000), diabetes mellitus (P=0.009) and thyroid hypofunction (P=0.000), odds ratio was 9.12, 4.18 and 37.55, respectively. The procedure of pacemaker replacement did not increase the risk of CIED infection (P>0.05). The body mass index (BMI) of male CIED infection patients, particularly of non-diabetic CIED infection men, was significantly lower than that of non-CIED infection men (P<0.05). Conclusion: The CIED infection rate is 0.9%, the vast majority showed pocket infection and coagulase-negative staphylococci are common pathogens. Implatation of ICD/CRT-D, diabetes mellitus and thyroid hypofunction are related risk factors of CIED infection; lower BMI men are more susceptible to CIED infection.

Key words： cardiovascular implantable electronic device infection coagulase negative staphylococcus body mass index

Received: 02 July 2013

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	FANG Danhong
	WU Gaojun
	LI Haiying
	LIN Jie
	HUANG Weijian.

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https://xb.wmu.edu.cn/EN/ OR https://xb.wmu.edu.cn/EN/Y2014/V44/I3/193

[1] Kurtz SM, Ochoa JA, Lau E, et al. Implantation trends and patient profiles for pacemakers and implantable cardioverter defibrillators in the United States: 1993-2006[J]. Pacing Clin Electrophysiol, 2010, 33(6): 705-711.

[2] Myerburg RJ. Implantable cardioverter-defibrillators after myocardial infarction[J]. N Engl J Med, 2008, 359(21):2245-2253.

[3] Bardy GH, Lee KL, Mark DB, et al. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure[J]. N Engl J Med, 2005, 352(3): 225-237.

[4] Voigt A, Shalaby A, Saba S. Continued rise in rates of cardio-vascular implantable device infection in the United States:temporal trends and causative insights[J]. Pacing Clin Electrophysiol, 2010, 33(4): 414-419.

[5] Greenspon AJ, Patel JD, Lau E, et al. Sixteen year trends in the infection burden for pacemakers and implantable cardioverter-defibrillators in the United States: 1993-2008 [J]. J Am Coll Cardiol, 2011, 58(10): 1001-1006.

[6] Baddour LM, Epstein AE, Erickson CC, et al. Update on cardiovascular implantable electronic device infections and their management. A scientific statement from the American Heart Association[J]. Circulation, 2010, 121(3): 458-477.

[7] Sohail MR, Uslan DZ, Khan AH, et al. Management and outcome of permanent pacemaker and implantable cardioverter-defibrillator infections[J]. J Am Coll Cardiol, 2007,49(18): 1851-1859.

[8] Tarakji KG, Chan EJ, Cantillon DJ, et al. Cardiac implantable electronic device infections: presentation, management, and patient outcomes[J]. Heart Rhythm, 2010, 7(8): 1043-1047.

[9] 计光, 李玲文, 王霄霞, 等. 经静脉永久心脏起搏器植入前后凝血功能的变化及临床意义[J]. 温州医学院学报, 2007, 37 (3): 212-214.

[10] Sohail MR, Wilson WR, Baddour LM. Infections of nonvalvular cardiovascular devices[M]//Mandell GL, Bennett JE, Dolin R, editors. Mandell, Douglas, and Bennett Prin-ciples and Practice of Infectious Diseases. Philadelphia:Churchill Livingstone/Elsevier, 2010: 1127-1142.

[11] Osmonov D, Ozcan KS, Erdinler I, et al. Cardiac devicerelated endocarditis: 31-Years experience[J]. J Cardiol, 2013,61(2): 175-180.

[12] Greenspon AJ, Prutkin JM, Sohail MR, et al. Timing of themost recent device procedure influences the clinical outcome of lead-associated endocarditis results of the MEDIC (Multicenter Electrophysiologic Device Infection Cohort) [J]. J Am Coll Cardiol, 2012, 59(7): 681-687.

[13] Dababneh AS, Sohail MR. Cardiovascular implantable electronic device infection: A stepwise approach to diagnosis

and management[J]. Cleve Clin J Med, 2011, 78(8): 529-537.

[14] 王世恒, 邹强, 史燕顺, 等. 凝固酶阴性葡萄球菌耐药性分析[J]. 临床医药实践, 2009,18(9): 681-682.

[15] Vuong C, Otto M. Staphylococcus epidermidis infections[J].Microbes Infect, 2002, 4(4): 481-489.

[16] Klug D, Balde M, Pavin D, et al. PEOPLE Study Group. Risk factors related to infections of implanted pacemakers and cardioverter-defibrillators: results of a large prospective study [J]. Circulation, 2007, 116(12): 1349-1355.

[17] Raad D, Irani J, Akl EG, et al. Implantable electrophysiologic cardiac device infections: a risk factor analysis[J]. Eur J Clin Microbiol Infect Dis, 2012, 31(11): 3015-3021.

[18] Lekkerkerker JC, van Nieuwkoop C, Trines SA, et al. Risk factors and time delay associated with cardiac device infections: Leiden device registry[J]. Heart, 2009, 95(9):715-720.

[19] Uslan DZ, Sohail MR, St Sauver JL, et al. Permanent pace-maker and implantable cardioverter defibrillator infection:a population-based study[J]. Arch Intern Med, 2007, 167 (7): 669-675.

[20] Dasgupta A, Montalvo J, Medendorp S, et al. Increased complication rates of cardiac rhythm management devices in ESRD patients[J]. Am J Kidney Dis, 2007, 49(5): 656-663.

[21] Ipek EG, Guray U, Demirkan B, et al. Infections of implantable cardiac rhythm devices: predisposing factors and outcome[J]. Acta Cardiol, 2012, 67(3): 303-310.