Bacterial Colonization and Infection of Electrophysiological Cardiac Devices Detected With Sonication and Swab Culture

Article

关键词: IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR;    HEART-FAILURE;    PROPIONIBACTERIUM-ACNES;    ENDOCARDITIS;    DIAGNOSIS;    RESYNCHRONIZATION;    PACEMAKER;    THERAPY;    SITE;   

DOI  :  10.1161/CIRCULATIONAHA.109.906461

来源: SCIE

【 摘 要 】

Background-Electrophysiological cardiac devices are increasingly used. The frequency of subclinical infection is unknown. We investigated all explanted devices using sonication, a method for detection of microbial biofilms on foreign bodies. Methods and Results-Consecutive patients in whom cardiac pacemakers and implantable cardioverter/defibrillators were removed at our institution between October 2007 and December 2008 were prospectively included. Devices (generator and/or leads) were aseptically removed and sonicated, and the resulting sonication fluid was cultured. In parallel, conventional swabs of the generator pouch were performed. A total of 121 removed devices (68 pacemakers, 53 implantable cardioverter/defibrillators) were included. The reasons for removal were insufficient battery charge (n = 102), device upgrading (n = 9), device dysfunction (n = 4), or infection (n = 6). In 115 episodes (95%) without clinical evidence of infection, 44 (38%) grew bacteria in sonication fluid, including Propionibacterium acnes (n = 27), coagulase-negative staphylococci (n = 11), Gram-positive anaerobe cocci (n = 3), Gram-positive anaerobe rods (n = 1), Gram-negative rods (n = 1), and mixed bacteria (n = 1). In 21 of 44 sonication-positive episodes, bacterial counts were significant (>= 10 colony-forming units/mL of sonication fluid). In 26 sterilized controls, sonication cultures remained negative in 25 cases (96%). In 112 cases without clinical infection, conventional swab cultures were performed: 30 cultures (27%) were positive, and 18 (60%) were concordant with sonication fluid cultures. Six devices and leads were removed because of infection, growing Staphylococcus aureus, Streptococcus mitis, and coagulase-negative staphylococci in 6 sonication fluid cultures and 4 conventional swab cultures. Conclusions-Bacteria can colonize cardiac electrophysiological devices without clinical signs of infection. (Circulation. 2010;121:1691-1697.)

【 授权许可】

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