心脏起搏器感染病PPT课件
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Manipulation of the device e.g. battery change or bloodstream infection
Pocket infection Local symptoms:
Pocket erythema, pain, swelling, warmth and erosion Draining sinus from pocket
心脏起搏器感染病
Mr. Chui, 81-years-old Presented with recurrent syncope Holter showed sick sinus syndrome VVI implanted in July 2005, procedure
uneventful
Endocarditis
At least 6 weeks IV cloxacillin
Timing of reimplantation
Replacement of pacing system on the opposite side of chest immediately
(1 stage)
countertraction technique Laser sheath
Surgical removal
Outcome after complete percutaneous removal of infected pacemaker systems and implantable cardiac defibrillators J.J Post, C. Alexopoulos, C. Fewtrell
Clinical presentations
Early infection (within one month) ~ 25% Procedure related
Late infection (within one year) ~ 33% Delayed infection (at least one year) ~ 42%
Internal Medicine Journal 36 (2006) 790-792
Endovascular lead extraction
Procedure related complications
Severe haemorrhage Tamponade Haematoma Transient hypotension Pulmonary embolism Tricuspid regurgitation Leads break
Followed up,
Noticed have painful erythematous lesion with scaling and pus-like discharge at lateral edge of pacing site
Wound was explored and cleaned again Cloxacillin was given
Cardiac device infections: getting to the heart of the matter. Uslan, Daniel Z; Baddour, Larry M. Current opinion in infectious Disease 19[4];346-348 August 2006
Hospital for removal of pacing lead by laser sheath due to suspected lead infection
However, patient refused lead removal because of the risk of the procedure
Treatment
Early removal of infected device Antibiotics
Without systemic symptoms/ bacteraemia
7- 10 days 2nd generation cephalosporin
Bacteraemia
At least 2 weeks IV cloxacillin if organism is methicillin sensitive
In Accident and Emergency department (AED),
Attended AED in Oct, 2005 and complained of pacer wound pain and swelling
Treated as cellulitis with ampicillin and cloxacillin 3 days later, attended AED again for increasing
Risk factors of cardiac device infection
Total number of device-related procedures Number of operators Procedure time Operator experience Temporary pacing leads prior to implantation Implanted central catheter
Among study period, there was a 49% rise in number of new devices implantation (from 159,585 in 1996 to 237,0 in 2003)
160% for ICDs and 31% PMs
The number of hospitalization with devices infection increased by 3.1-fold (2.8-fold for PMs, 6-fold for ICDs)
or Period of temporary pacing, then replace the pacemaker after antibiotics
(2 stages)
Removal of leads
Endovascular leads extraction:
Traction Byrd myocardial
~End~
pacer wound pain and swelling
Incision and drainage was done in AED !! Referred to general clinic for wound dressing !!
Noticed pacemaker exposed by general clinic nurse
Emergency operation arranged and pacer was removed
Wound swabs were taken Pocket was cleaned by hydrogen peroxide
Put on a course of cefazolin
As the patient remained asymptomatic after removal of pacer, he refused to have pacemaker implantation
Prevalence of Cardiac Device implantation
Infection of permanent pacemaker systems is uncommon, occurring in approximately ~1-7% of implanted pacing system
Admitted to medical ward and cardiologist was then informed at this juncture
Open wound with pacer exposed Afebrile
Treated as infected pacing wound with exposure of the pacer box
together with the underlying and surrounding tissue (? due to the irritation of the tissue by the pacing leads or underlying chronic infection)
Granuloma regrew after surgery Eventually, patient was referred to Queen Elizabeth
Systemic symptoms:
fever, malaise, nausea, anorexia
Endocarditis
Common Organisms
Coagulase-negative staphylococci Staphylococcus aureus Gram negative bacilli
Wound swabs yield MSSA in both occasions
However, granuloma developed over the pacer wound again
Cauterization by silver nitrate tried but failed Surgeron was consulted for surgical removal of granuloma
The pacer lead was cut short with radical sterilization done by hydrogen peroxide
No granuloma was seen afterwards Patient remained asymptomatic
Pacemaker infection review
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;590-591
Pocket infection Local symptoms:
Pocket erythema, pain, swelling, warmth and erosion Draining sinus from pocket
心脏起搏器感染病
Mr. Chui, 81-years-old Presented with recurrent syncope Holter showed sick sinus syndrome VVI implanted in July 2005, procedure
uneventful
Endocarditis
At least 6 weeks IV cloxacillin
Timing of reimplantation
Replacement of pacing system on the opposite side of chest immediately
(1 stage)
countertraction technique Laser sheath
Surgical removal
Outcome after complete percutaneous removal of infected pacemaker systems and implantable cardiac defibrillators J.J Post, C. Alexopoulos, C. Fewtrell
Clinical presentations
Early infection (within one month) ~ 25% Procedure related
Late infection (within one year) ~ 33% Delayed infection (at least one year) ~ 42%
Internal Medicine Journal 36 (2006) 790-792
Endovascular lead extraction
Procedure related complications
Severe haemorrhage Tamponade Haematoma Transient hypotension Pulmonary embolism Tricuspid regurgitation Leads break
Followed up,
Noticed have painful erythematous lesion with scaling and pus-like discharge at lateral edge of pacing site
Wound was explored and cleaned again Cloxacillin was given
Cardiac device infections: getting to the heart of the matter. Uslan, Daniel Z; Baddour, Larry M. Current opinion in infectious Disease 19[4];346-348 August 2006
Hospital for removal of pacing lead by laser sheath due to suspected lead infection
However, patient refused lead removal because of the risk of the procedure
Treatment
Early removal of infected device Antibiotics
Without systemic symptoms/ bacteraemia
7- 10 days 2nd generation cephalosporin
Bacteraemia
At least 2 weeks IV cloxacillin if organism is methicillin sensitive
In Accident and Emergency department (AED),
Attended AED in Oct, 2005 and complained of pacer wound pain and swelling
Treated as cellulitis with ampicillin and cloxacillin 3 days later, attended AED again for increasing
Risk factors of cardiac device infection
Total number of device-related procedures Number of operators Procedure time Operator experience Temporary pacing leads prior to implantation Implanted central catheter
Among study period, there was a 49% rise in number of new devices implantation (from 159,585 in 1996 to 237,0 in 2003)
160% for ICDs and 31% PMs
The number of hospitalization with devices infection increased by 3.1-fold (2.8-fold for PMs, 6-fold for ICDs)
or Period of temporary pacing, then replace the pacemaker after antibiotics
(2 stages)
Removal of leads
Endovascular leads extraction:
Traction Byrd myocardial
~End~
pacer wound pain and swelling
Incision and drainage was done in AED !! Referred to general clinic for wound dressing !!
Noticed pacemaker exposed by general clinic nurse
Emergency operation arranged and pacer was removed
Wound swabs were taken Pocket was cleaned by hydrogen peroxide
Put on a course of cefazolin
As the patient remained asymptomatic after removal of pacer, he refused to have pacemaker implantation
Prevalence of Cardiac Device implantation
Infection of permanent pacemaker systems is uncommon, occurring in approximately ~1-7% of implanted pacing system
Admitted to medical ward and cardiologist was then informed at this juncture
Open wound with pacer exposed Afebrile
Treated as infected pacing wound with exposure of the pacer box
together with the underlying and surrounding tissue (? due to the irritation of the tissue by the pacing leads or underlying chronic infection)
Granuloma regrew after surgery Eventually, patient was referred to Queen Elizabeth
Systemic symptoms:
fever, malaise, nausea, anorexia
Endocarditis
Common Organisms
Coagulase-negative staphylococci Staphylococcus aureus Gram negative bacilli
Wound swabs yield MSSA in both occasions
However, granuloma developed over the pacer wound again
Cauterization by silver nitrate tried but failed Surgeron was consulted for surgical removal of granuloma
The pacer lead was cut short with radical sterilization done by hydrogen peroxide
No granuloma was seen afterwards Patient remained asymptomatic
Pacemaker infection review
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;590-591