心臟植入式電子裝置感染與預防

Management and Prevention of Cardiac Implantable Electronic Device Infections

心臟是人類的核心器官，心臟節律性的規則運作才能維持身體的正常功能，節律異常的心臟疾病困擾臨床醫師，直到 1958 年，人類史上第一個心臟節律器裝置出現，經過快速不斷的創新與改良，迄今美國已有超過四百萬人接受此類的節律裝置，但伴隨而來的裝置感染引起另一種醫療問題，粗估感染發生率為 1.5~2.4%。心臟植入式電子裝置的感染因素可能和宿主、裝置類型與植入技術複雜程度有關，文獻指出引起感染的危險因子如：潛在內科共病、腎衰竭、心衰竭、糖尿病、抗凝固劑與類固醇使用，引起的致病菌以革蘭氏陽性菌為主，其中以金黃色葡萄球菌較常見。臨床表徵為局部紅、腫、熱、痛、化膿性分泌物、潰瘍等，也可產生敗血症或感染性心內膜炎。局部感染以保守性治療為主，主要是接受有效抗微生物製劑 7~14 天，全身性感染需要移除裝置與延長藥物治療時間。預防感染有效的方式為術前預防性抗生素使用，或是使用包覆有抗微生物製劑的電子裝置，有效減少術後出血腫塊產生也能降低心臟植入式電子裝置的感染。

The heart is a vital organ for human beings, and its regular rhythmicperformance ensures the proper functioning of the body. Clinical physicianswere concerned about heart pacing disorder-related diseases until 1958, when thefirst pacemaker in medical history was utilized. More than four million peoplehave received cardiac implantable electronic devices (CIEDs) after rapid cardiacdisease development and intervention over the past half century. However, cardiacimplantable electronic device infections brought upon other medical issues. Thecrude incidence of CIED infection is 1.5-2.4%, and electronic device infectionsmay be attributed to patient factors, device types, and the number of devicerelatedinterventions. The significant risk factors for patient comorbidities aremedical illness, renal failure, heart failure, diabetes, usage of anti-coagulant agents,and steroids. Gram-positive bacteria are usually the cause of infection, of whichStaphylococcus aureus is the most common. Clinical manifestations include skinreddening, warmth, edema, pain, purulent discharge, and erosion, and sometimes,severe sepsis and infective endocarditis. Conservative medical therapy may controllocalized infection, usually after 7-14 days of antimicrobial agent use. Systemicinfections require removal of the electronic device and longer durations of antiinfectiontherapy. Strategies to prevent device infections have been proposed, suchas pre-procedure prophylaxis antimicrobial agents, antimicrobial agent-coveredenvelopes for electronic devices, and measures to decrease the growth of postprocedurehematomas.