心臟起搏器感染病課件

1、Pacemaker infection Case presentationDr. Cheuk Ming Yan, Candy Alice Ho Miu Ling Nethersole HospitalMr. Chui, 81-years-oldPresented with recurrent syncopeHolter showed sick sinus syndromeVVI implanted in July 2005, procedure uneventfulIn Accident and Emergency department (AED),Attended AED in Oct, 2

2、005 and complained of pacer wound pain and swellingTreated as cellulitis with ampicillin and cloxacillin3 days later, attended AED again for increasing pacer wound pain and swellingIncision and drainage was done in AED ! Referred to general clinic for wound dressing !Noticed pacemaker exposed by gen

3、eral clinic nurseAdmitted to medical ward and cardiologist was then informed at this junctureOpen wound with pacer exposed AfebrileTreated as infected pacing wound with exposure of the pacer boxEmergency operation arranged and pacer was removedWound swabs were takenPocket was cleaned by hydrogen per

4、oxidePut on a course of cefazolinAs the patient remained asymptomatic after removal of pacer, he refused to have pacemaker implantationFollowed up,Noticed have painful erythematous lesion with scaling and pus-like discharge at lateral edge of pacing siteWound was explored and cleaned againCloxacilli

5、n was givenWound swabs yield MSSA in both occasionsHowever, granuloma developed over the pacer wound againCauterization by silver nitrate tried but failedSurgeron was consulted for surgical removal of granuloma together with the underlying and surrounding tissue (? due to the irritation of the tissu

6、e by the pacing leads or underlying chronic infection)Granuloma regrew after surgeryEventually, patient was referred to Queen Elizabeth Hospital for removal of pacing lead by laser sheath due to suspected lead infectionPrevalence of Cardiac Device implantationInfection of permanent pacemaker systems

7、 is uncommon, occurring in approximately 1-7% of implanted pacing systemAmong study period, there was a 49% rise in number of new devices implantation (from 159,585 in 1996 to 237,720 in 2003)160% for ICDs and 31% PMsThe number of hospitalization with devices infection increased by 3.1-fold (2.8-fol

8、d for PMs, 6-fold for ICDs)Rising Rates of Cardiac Rhythm Management Device Infections in the Unites States:1996 through 2003 Andrew Viogt, Alaa Shalaby, and Samir Saba J.Am. Coll. Cardiol. 2006;48;590-591Clinical presentationsEarly infection (within one month) 25%Procedure relatedLate infection (wi

9、thin one year) 33%Delayed infection (at least one year) 42%Manipulation of the device e.g. battery change or bloodstream infectionPocket infection Local symptoms:Pocket erythema, pain, swelling, warmth and erosionDraining sinus from pocketSystemic symptoms:fever, malaise, nausea, anorexiaEndocarditi

10、sCommon OrganismsCoagulase-negative staphylococci Staphylococcus aureusGram negative bacilliRemoval of leadsEndovascular leads extraction:Traction Byrd myocardial countertraction techniqueLaser sheathSurgical removalOutcome after complete percutaneous removal of infected pacemaker systems and implantable cardiac defibrillators J.J Post, C. Alexopoulos, C. Fewtrell Internal Medicine Journal 36 (2006) 790-792Endovas