心脏植入性电子设备早发和晚发感染的临床特征和预后  

Clinical characteristics and prognosis of cardiovascular implantable electronic device surgery patients with early- and late-onset infection

作　　者：褚松筠[1] 王玉玲[1] 齐心[2] 王禹川[3] 李康[1] 盛琴慧[1] 蒋捷[1] 周菁[1] CHU Song-yun;WANG Yu-ling;QI Xin;WANG Yu-chuan;LI Kang;SHENG Qin-hui;JIANG Jie;ZHOU Jing(Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院心内科,北京100034 [2]北京大学第一医院整形烧伤科,北京100034 [3]北京大学第一医院老年科,北京100034

出　　处：《中华医院感染学杂志》2022年第1期71-75,共5页Chinese Journal of Nosocomiology

基　　金：国家重点研发计划基金资助项目(2017YFC1307704)。

摘　　要：目的 调查心脏植入性电子设备(CIED)术后早发和晚发感染的不同临床特征和预后,探讨可能的诊治策略。方法 回顾性分析北京大学第一医院自2006年至今发生CIED感染的连续患者队列中早发及晚发感染者的临床特征以及预后差异。结果 共纳入54例患者,早发感染组22例,晚发感染组32例。早发和晚发感染的中位发生时间分别为1.0个月和21.0个月。早发感染组中女性占比较高,晚发感染组糖尿病和慢性阻塞性肺病患者倾向占比较高(P=0.05及P<0.05),早发CIED感染患者较多植入心脏复律除颤器(ICD)或心脏再同步化治疗(CRT-D)(P=0.001),较多倾向发生囊袋血肿(P=0.001),红肿(P=0.001),积液(P=0.046),发热(P=0.050),寒战(P=0.050),并有1例脓毒血症。而晚发感染较多表现为囊袋破溃(P=0.032)和侵蚀(P=0.001),全身表现不显著。早发感染组中1例患者血培养阳性,病原体为金黄色葡萄球菌;而晚发感染组血培养未见阳性。晚发感染组囊袋组织培养阳性比例更高(P=0.021),病原体更多见凝固酶阴性表皮葡萄球菌。晚发感染组中更多患者进行了清创(P=0.019)和起搏系统完全拔除(P=0.044),但之后经历较短的时间发生心脏原因再入院(P=0.042),并倾向于有较短的生存期。结论 半数以上CIED相关的感染出现于距上一次器械操作6个月以上,更多见于患多种合并症的患者并表现为CIED囊袋无痛性破溃。虽然充分清创和拔除起搏系统有助于控制感染,但总体晚发感染患者预后不佳,需要充分关注。OBJECTIVE To investigate the clinical characteristics and prognosis of the patients with early-onset and late-onset infection after cardiovascular implantable electronic device(CIED) surgery and explore feasible treatment strategies. METHODS Consecutive patients with CIED infection in Peking University First Hospital since 2006 were recruited as the study objects, the clinical characteristics and prognosis of the patients with early-onset and late-onset infection were retrospectively analyzed. RESULTS The cohort included 54 subjects, 22 in the early group and 32 in the late group. The median time of infection was 1.0 and 21.0 months after the procedures. There tended to be more females in the early group and more diabetes and chronic obstructive pulmonary disease in the late group(P=0.050 and P<0.05). Patients in the early infection group had more implantable cardioverter-defibrillator(ICD) or cardiac resynchronization therapy(CRT-D)implantation(P=0.001). They were more likely to present with post-op hematoma(P=0.001), pocket erythema and swelling(P=0.001), pocket effusion(P=0.046], fever(P=0.050), and chills(P=0.050). Additionally, there was one subject who developed septicemia. Late infections were more likely to have pocket diabrosis(P=0.032) and erosion(P=0.001) but no significant systemic manifestations. There was one case with positive blood culture in the early-onset infection group, and the pathogen was Staphylococcus aureus;while there was no case with positive blood culture in the late-onset infection group. The proportion of the patients with positive culture of pocket tissues was significantly higher in the late-onset infection group than in the early-onset infection group(P=0.021), and coagulase-negative staphylococci were the more common species of pathogen. Debridement(P=0.019) and removal of pacing systems(P=0.044) were more conducted in patients with late infections. Despite these approaches, the subjects with late infection had more cardiac readmission(P=0.042) and tended to have a shorter survi

关 键 词：心脏植入式电子设备 感染 培养 病原菌 

分 类 号：R54[医药卫生—心血管疾病]