心脏起搏器感染病.ppt

Pacemaker infection Case presentation Mr. Chui, 81-years-old Presented with recurrent syncope Holter showed sick sinus syndrome VVI implanted in July 2005, procedure uneventful 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 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 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 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 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 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 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 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 The pacer lead was cut short with radical sterilization done by hydrogen peroxide No granuloma was seen afterwards Patient remained asymptomatic Pacemaker infection review Prevalence of Cardiac Device implantation Infe