Long-term infection rates associated with the pectoral versus abdominal approach to cardioverter-defibrillator implants
Long-term infection rates associated with the pectoral versus abdominal approach to cardioverter-defibrillator implants
复制标题
DOI：
10.1016/s0002-9149(01)01845-8
复制
发表时间：
2001-10-01
影响因子：
2.8
通讯作者：
Galvin, JM
中科院分区：
文献类型：
--
作者：
Mela, T;McGovern, BA;Galvin, JM
感染是植入式心律转复除颤器 (ICD) 植入后一种罕见（0% 至 6.7%）但严重的并发症。 1983 年 4 月至 1999 年 5 月期间在马萨诸塞州总医院进行的所有 ICD 初次植入、置换或翻修均经过审查。在 1,700 例手术中，总共发现了 21 例 ICD 相关感染 (1.2%)，影响了 1, 170 名接受初次植入、更换发电机或修改系统的患者中的 1.8%。平均随访时间为 35 +/- 33 个月。在 959 名长期随访患者中，584 名腹部系统患者中的 19 名（3.2%）和 375 名胸部系统患者中的 2 名（0.5%）出现了 ICD 相关感染（p = 0.03）。 959 例初次 ICD 植入和 447 例替换或系统修复之间的感染率没有显着差异。只有 5 名患者 (24%) 出现全身感染症状，包括发烧 (T > 100.5) 和白细胞计数升高 > 12,000。伤口培养结果显示 16 名患者 (76%) 存在葡萄球菌。 19 名患者接受了移除整个 ICD 系统以及静脉注射抗生素 2 至 4 周的治疗。自经静脉胸腔系统出现以来，ICD 相关感染的发生率有所下降。造成 ICD 感染的主要微生物是葡萄球菌。 ICD 感染管理的主要内容是完全移除整个植入系统。 (C) 2001 年，Excerpta Medica, Inc.
Infection is an uncommon (0% to 6.7%) but serious complication after implantable cardioverter-defibrillator (ICD) implantation. All ICD primary implants, replacements, or revisions performed at the Massachusetts General Hospital between April 1983 and May 1999 were reviewed. A total of 21 ICD-related infections (1.2%) were identified among 1,700 procedures affecting 1.8% of the 1, 170 patients who underwent a primary implant, a generator change, or a revision of their systems. The mean follow-up time was 35 +/- 33 months. Of the 959 patients with long-term follow-up, 19 of the 584 patients (3.2%) with abdominal and 2 of the 375 patients (0.5%) with pectoral systems developed ICD-related infections (p = 0.03). There was no significant difference between the infection rate among the 959 primary ICD implants and the 447 replacements or system revisions. Only 5 of the patients (24%) had systemic signs of infection, including fever (T> 100.5) and elevated white blood count > 12,000. Cultures from the wound revealed staphylococcal species in 16 patients (76%). Nineteen patients were treated with removal of the entire ICD system in addition to intravenous antibiotics for 2 to 4 weeks. A decrease in the incidence of ICD-related infection has occurred since the advent of transvenous pectoral systems. The main organism responsible for ICD infection is Staphylococcus. The mainstay of ICD infection management consists of complete removal of the entire implanted system. (C) 2001 by Excerpta Medica, Inc.