Fungal infection of implantable cardioverter-defibrillators: case series of five patients managed over 22 years.
Fungal infection of implantable cardioverter-defibrillators: case series of five patients managed over 22 years.
复制标题
植入式心律转复除颤器的真菌感染：对 5 名患者进行超过 22 年管理的病例系列。
DOI：
10.1016/j.hrthm.2006.04.012
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发表时间：
2006
期刊：
影响因子：
5.5
通讯作者：
Ellinor,PatrickT
中科院分区：
文献类型：
--
作者：
Ho,IvanCK;Milan,DavidJ;Mansour,MoussaC;Mela,Theofanie;Guy,MaryL;Ruskin,JeremyN;Ellinor,PatrickT
背景随着植入式心律转复除颤器（ICD）的使用越来越多，器械并发症也越来越常见。真菌相关的ICD感染很少被报道，并且对这些病态感染的表现、患病率和治疗选择知之甚少。方法：我们对在一个学术中心进行的ICD手术进行了回顾性分析，并确定了所有的ICD-在1983年至2005年进行的3，648例ICD相关手术中，我们确定了47例（1.3%）ICD感染病例，其中5例（0.1%）是由于真菌病原体。真菌感染更可能与腹部器械相关，发生局部感染而非全身感染，并且从最初植入到就诊的持续时间更长。所有患者均接受ICD系统植入和抗真菌治疗。结论ICD真菌感染是一种罕见但严重的并发症，必须积极治疗，完全硬件植入和长期抗真菌治疗。由于大多数感染是晚期并发症，起病缓慢，因此需要高度的临床怀疑才能早期诊断。
BACKGROUNDWith the increasing use of implantable cardioverter-defibrillators (ICDs), device complications are becoming more common. Fungal-related ICD infections have rarely been reported, and little is known about the presentation, prevalence, and treatment options for these morbid infections.OBJECTIVESThe purpose of this study was to characterize the clinical features, treatment, and outcomes of patients with fungal ICD infections.METHODSWe performed a retrospective review of ICD procedures performed at a single academic center and identified all ICD-related infections managed between 1983 and 2005.RESULTSAmong a total of 3,648 ICD-related procedures performed between 1983 and 2005, we identified 47 (1.3%) cases of ICD infections, of which 5 (0.1%) were due to a fungal pathogen. Fungal infections were more likely to be associated with abdominal devices, to have a local rather than systemic infection, and to have a longer duration from the original implant to presentation. All patients were treated with ICD system explantation and antifungal therapy.CONCLUSIONFungal infection of ICDs is a rare but serious complication of device implantation that must be treated aggressively with complete hardware explantation and prolonged antifungal therapy. Because most infections are late complications and have indolent onsets, a high level of clinical suspicion is required for early diagnosis.