Accuracy of Swabs, Tissue Specimens, and Lead Samples in Diagnosis of Cardiac Rhythm Management Device Infections

PACE - Pacing and Clinical Electrophysiology - Tập 32 Số s1 - 2009
Pier Giorgio Golzio1, Melissa Vinci1, Matteo Anselmino1, Chiara Comoglio2, Mauro Rinaldi2, Gian Paolo Trevi1, Maria Grazia Bongiorni3
1University Cardiology, Department of Internal Medicine, San Giovanni Battista Hospital, University of Turin, Torino, Italy
2University Cardiac Surgery, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Turin, Torino, Italy
3University Cardiology, Cardio‐Thoracic Department, Cisanello Hospital, University of Pisa, Pisa, Italy

Tóm tắt

Aims: Pacemaker and implantable‐cardioverter defibrillator lead infections widely increased with consequent need to accurately recognize responsible bacteria. Methods: Between May 2003 and December 2007, we extracted 118 leads, 104 (87.3%) due to infections (sepsis, lead‐associated endocarditis, pocket infection) or chronic draining sinus (with negative local bacteriological analyses). Swabs and tissue specimens from pocket and fragments of pin and tip of each extracted lead were obtained during extraction and sent for bacteriological examination. Results: Cultures from explanted lead pins returned positive results in 100% of the cases presenting with local infections and in 92.5% of those with chronic draining sinus. In cases of sepsis, positive results of blood samples are less common than lead samples (58.3 vs 86.7, P = 0.02), the latter being more sensitive for infection diagnosis. Concordance between bacterial isolates from pocket and lead is quite low, approaching 45%, seemingly due to contamination effect. Concordance between isolates within the lead (pin and tip) is quite high, close to 70%, reflecting a more accurate expression of the real infection. In cases of sepsis, concordance between lead and blood samples, and mainly from tip and blood, is very high, resembling 80–85%; consequently bacterial isolates from the lead, particularly from lead tip, are clearly associated with clinical infections. Conclusions: Our results strongly support the hypothesis that chronic draining sinus is often sustained by infection. Moreover, diagnostic accuracy of lead samples is higher not only than swabs and tissue samples, but also than blood samples to confirm an infection and to guide effective therapy.

Từ khóa


Tài liệu tham khảo

10.1016/j.jacc.2006.05.016

Bongiorni MG, 2007, Techniques for transvenous leads extraction, Minerva Cardioangiol, 55, 771

Bongiorni MG, 2005, Pacing and implantable cardioverter‐defibrillator transvenous lead extraction, Ital Heart J, 6, 261

10.1111/j.1540-8159.2000.tb00845.x

10.1378/chest.124.4.1451

Victor F, 1995, Infections on permanent endocavitary pacemaker leads: Value of transesophageal echocardiography, Arch Mal Coeur Vaiss, 88, 1875

10.1161/01.CIR.95.8.2098

10.1136/hrt.81.1.82

10.1016/S0003-4975(01)02726-6

10.1111/j.1540-8159.2000.tb00940.x

10.1016/S0002-8703(03)00188-1

10.1016/j.ehj.2003.07.006

10.1111/j.1540-8159.2006.00328.x

10.1111/j.1540-8159.2005.00268.x

10.1016/j.ahj.2004.07.032

10.1136/hrt.2003.010595

10.1056/NEJMra035415

10.1097/01.sap.0000261846.73531.2e

10.1016/j.ahj.2004.07.032

10.1111/j.1540-8159.2007.00852.x

Thông tin
Thông tin xuất bản

PACE - Pacing and Clinical Electrophysiology

Tập 32 Số s1

Thông tin tác giả