avkАрхивъ внутренней медициныThe Russian Archives of Internal Medicine2226-67042411-6564“SINAPS” LLC10.20514/2226-6704-2017-7-3-233-240avk-660Research ArticleРАЗБОР КЛИНИЧЕСКИХ СЛУЧАЕВANALYSIS OF CLINICAL CASESИНФЕКЦИИ, АССОЦИИРОВАННЫЕ С ИМПЛАНТАЦИЕЙ КАРДИОСТИМУЛЯТОРОВINFECTION ASSOCIATED WITH THE IMPLANTATION OF CARDIOVASCULAR IMPLANTABLE ELECTRONIC DEVICESДворецкийЛ. И.DvoretskyL. I.

кафедра госпитальной терапии № 2

Faculty of Medicine, Chair of Internal Medicine No.2

ak412mma@gmail.comВаколюкР. М.VakolukR. M.

кафедра госпитальной терапии № 2

Faculty of Medicine, Chair of Internal Medicine No.2

ak412mma@gmail.comКаптаеваА. К.KaptaevaA. K.

кафедра госпитальной терапии № 2

Faculty of Medicine, Chair of Internal Medicine No.2

ak412mma@gmail.comДорощукС. А.DoroshukS. A.ak412mma@gmail.comФГБОУ ВО Первый Московский Государственный Медицинский Университет им. И.М. СеченоваРоссияI.M. Sechenov First Moscow State Medical UniversityRussian FederationГБУЗ Госпиталь для Ветеранов Войн № 3 Департамента Здравоохранения, МоскваРоссияHospital Veterans of Wars № 3 Department of Moscow Health, MoscowRussian Federation20172805201773233240Copyright © Дворецкий Л.И., Ваколюк Р.М., Каптаева А.К., Дорощук С.А., 20172017Дворецкий Л.И., Ваколюк Р.М., Каптаева А.К., Дорощук С.А.Dvoretsky L.I., Vakoluk R.M., Kaptaeva A.K., Doroshuk S.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.medarhive.ru/jour/article/view/660

В статье приводятся данные о частоте, характере, факторах риска и диагностике инфекционных осложнений (ИКИ) у больных с кардиоимплантированными электронными устройствами (КИЭУ) — искусственными водителями ритма, кардиодефибрилляторами, устройствами для кардиосинхронизирующей терапии — зачастую прогностически неблагоприятных, сопровождающихся высокой летальностью. Приводятся данные крупномасштабного ретроспективного анализа 200 219 больных с КИЭУ на протяжении 3-х летнего периода после имплантации. Отмечено, что среди лиц с ИКИ регистрировалась более высокая смертность по сравнению с пациентами без признаков инфекции. При анализе случаев ИКИ выделяются основные факторы риска их развития, в т.ч. наличие сопутствующей патологии. В статье рассматриваются основные типы микроорганизмов, выделяемые у больных с наличием ИКИ, клиническая симптоматика ИКИ, приводится диагностический алгоритм при подозрении на ИКИ. Особенностью представленного в статье клинического случая является относительно раннее развитие ИКИ с поражением клапанных структур (трикуспидального клапана) — первые симптомы бактериального поражения появились через 6 месяцев после операции. Обычно инфекционный эндокардит у больных с ИКЭУ верифицировался в различные сроки после имплантации — от 1 до 72 месяцев, причем в большинстве случаев не ранее чем через 3 месяца. Основными клиническими проявлениями заболевания была рецидивирующая лихорадка, в связи с чем больной неоднократно госпитализировался на протяжении нескольких месяцев в различные лечебные учреждения. В каждом стационаре тактика ведения больного была различной и не отвечала принятым стандартам диагностического поиска у лихорадящего больного с ИКЭУ. Только при третьей госпитализации больного (ноябрь 2015 г.) при проведении ТТЭ были выявлены вегетации на створках трикуспидального клапана. Приведенное клиническое наблюдение свидетельствует не только о сложностях диагностики ИЭ у больных с наличием ИКЭУ, но и о неизбежных ошибках ведения данной категории пациентов при несоблюдении стандартов диагностики и лечения ИЭ. Авторами подчеркивается, что в процессе диагностического поиска, а в последующем и при выработке тактики лечения необходимо следовать Рекомендациям Европейского общества кардиологов у пациентов инфекционным эндокардитом 2015 г.

 

Data on the frequency, nature, risk factors and diagnosis of infectious complications (IC) in patients with cardioimplanted electronic devices (CED) — artificial rhythm drivers, cardiodefibrillators, devices for cardiosynchronizing therapy — often prognostically unfavorable, accompanied by high mortality, are given in the article. The data of a large-scale retrospective analysis of 200 219 patients with CED are given during the 3-year period after implantation. It was noted that among persons with IC there was a higher mortality rate compared to patients without signs of infection. In the analysis of cases of IC, the main risk factors for their development are identified, including. Presence of concomitant pathology. This article discusses the basic types of microorganisms were isolated from patients with the presence of IC, IC clinical symptoms, provides a diagnostic algorithm for suspected IC. A feature of the clinical case presented in the article is a relatively early development of IC with damage to the valve structures (tricuspid valve) — the first symptoms of bacterial damage appeared 6 months after the operation. Usually infectious endocarditis in patients with CED was verified at various times after implantation — from 1 to 72 months, and in most cases not earlier than 3 months later. The main clinical manifestations of the disease were recurrent fever, which is why the patient was repeatedly hospitalized for several months in various medical institutions. In each hospital, the patient management tactics were different and did not meet the accepted standards of diagnostic search in a febrile patient with CED. Only with the third hospitalization of the patient (November 2015) during the transthoracic echocardiography were revealed vegetations on the valves of the tricuspid valve. The given clinical observation testifies not only to the difficulties of diagnosing IE in patients with the presence of CED, but also about the inevitable mistakes in maintaining this category of patients when the standards for diagnosis and treatment of IE are not complied with. The authors emphasize that in the course of diagnostic search, and later in the development of treatment tactics, it is necessary to follow the ESC Guidelines for the management of infective endocarditis in 2015.

 

кардиоимплантированные электронные устройстваискусственные водители ритмакардиовертеры-дефибрилляторыинфекции кардиоимплантовинфекционный эндокардитcardiac implantable electronic devicespacemakerscardiac defibrillatorsinfections of cardiac implantsinfective endocarditisReferencesKurtz S.M., Ochoa J.A., Lau E. Implantation trends and patient profiles for pacemakers and implantable cardioverter defibrillators in the United States: 1993-2006. Pacing. Clin. Electrophysiol. 2010; 33: 705-711.Kurtz S.M., Ochoa J.A., Lau E. Implantation trends and patient profiles for pacemakers and implantable cardioverter defibrillators in the United States: 1993-2006. Pacing. Clin. Electrophysiol. 2010; 33: 705-711.Mond H.G., Irwin M., Ector H., Proclemer A. The world survey of cardiac pacing and cardioverter defibrillators: calendar year 2005: an International Cardiac Pacing and Electrophysiology Society (ICPES) project. Pacing. Clin. Electrophysiol. 2008; 31: 1202-1212.Mond H.G., Irwin M., Ector H., Proclemer A. The world survey of cardiac pacing and cardioverter defibrillators: calendar year 2005: an International Cardiac Pacing and Electrophysiology Society (ICPES) project. Pacing. Clin. Electrophysiol. 2008; 31: 1202-1212.Uslan D.Z., Tleyjeh I.M., Baddour L.M. et al. Temporal trends in permanent pacemaker implantation: a population study. Am. Heart. J. 2008; 155: 896-903.Uslan D.Z., Tleyjeh I.M., Baddour L.M. et al. Temporal trends in permanent pacemaker implantation: a population study. Am. Heart. J. 2008; 155: 896-903.Myerburg R.J. Implantable cardioverter-defibrillators after myocardial infarction. N. Engl. J. Med. 2008; 359: 2245-2253.Myerburg R.J. Implantable cardioverter-defibrillators after myocardial infarction. N. Engl. J. Med. 2008; 359: 2245-2253.Bardy G.H., Lee K.L., Mark D.B. Sudden cardiac death in heart failure trial (SCD-HeFT). Amiodarone or an implantable defibrillator for congestive heart failure. N. Engl. J. Med. 2005; 352: 225-237.Bardy G.H., Lee K.L., Mark D.B. Sudden cardiac death in heart failure trial (SCD-HeFT). Amiodarone or an implantable defibrillator for congestive heart failure. N. Engl. J. Med. 2005; 352: 225-237.Moss A.J., Zareba W., Hall W.J. Multicenter Automatic Defibrillator Implantation Trial II Investigators Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N. Engl. J. Med. 2002; 346: 877-883.Moss A.J., Zareba W., Hall W.J. Multicenter Automatic Defibrillator Implantation Trial II Investigators Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N. Engl. J. Med. 2002; 346: 877-883.Mond H., Irwin M., Morillo C., Ector H. The world survey of cardiac pacing and cardioverter defibrillators: calendar year 2001. Pacing. Clin. Electrophysiol. 2004; 27: 955–964.Mond H., Irwin M., Morillo C., Ector H. The world survey of cardiac pacing and cardioverter defibrillators: calendar year 2001. Pacing. Clin. Electrophysiol. 2004; 27: 955–964.Baddour L.M., Epstein A.E., Erickson C.C. Update on cardiovascular implantable electronic device infections and their management. A scientific statement from the American Heart Association. Circulation. 2010; 121: 458-477.Baddour L.M., Epstein A.E., Erickson C.C. Update on cardiovascular implantable electronic device infections and their management. A scientific statement from the American Heart Association. Circulation. 2010; 121: 458-477.Sohail M.R., Henrikson C.A., Braid-Forbes M.J. et al. Increased Long-Term Mortality in Patients with Cardiovascular Implantable Electronic Device Infections. PACE 2015; 38: 231–239.Sohail M.R., Henrikson C.A., Braid-Forbes M.J. et al. Increased Long-Term Mortality in Patients with Cardiovascular Implantable Electronic Device Infections. PACE 2015; 38: 231–239.Greenspon A.J., Patel J.D., Lau E. et al. 16-Year Trends in the Infection Burden for Pacemakers and Implantable Cardioverter-Defibrillators in the United States: 1993 to 2008. J. Am. Coll. Cardiol. 2011; 58(10): 1001-1006.Greenspon A.J., Patel J.D., Lau E. et al. 16-Year Trends in the Infection Burden for Pacemakers and Implantable Cardioverter-Defibrillators in the United States: 1993 to 2008. J. Am. Coll. Cardiol. 2011; 58(10): 1001-1006.Darouiche R.O. Treatment of infections associated with surgical implants. N. Engl. J. Med. 2004; 350: 1422-1429.Darouiche R.O. Treatment of infections associated with surgical implants. N. Engl. J. Med. 2004; 350: 1422-1429.Sohail M.R., Uslan D.Z., Khan A.H. Management and outcome of permanent pacemaker and implantable cardioverter-defibrillator infections. J. Am. Coll. Cardiol. 2007; 49: 1851-1859.Sohail M.R., Uslan D.Z., Khan A.H. Management and outcome of permanent pacemaker and implantable cardioverter-defibrillator infections. J. Am. Coll. Cardiol. 2007; 49: 1851-1859.Eggimann P., Waldvogel F. Infections associated with indwelling medical devices. Washington DC: Am. Soc. Microbiol. Press; 2000. Pacemaker and defibrillator infections; p. 247Eggimann P., Waldvogel F. Infections associated with indwelling medical devices. Washington DC: Am. Soc. Microbiol. Press; 2000. Pacemaker and defibrillator infections; p. 247Cabell C.H., Heidenreich P.A., Chu V.H. Increasing rates of cardiac device infections among Medicare beneficiaries: 1990–1999. Am. Heart J. 2004; 147: 582-586.Cabell C.H., Heidenreich P.A., Chu V.H. Increasing rates of cardiac device infections among Medicare beneficiaries: 1990–1999. Am. Heart J. 2004; 147: 582-586.Voigt A., Shalaby A., Saba S. Continued rise in rates of cardiovascular implantable device infection in the United States: temporal trends and causative insights. Pacing. Clin. Electrophysiol. 2010; 33: 414-419.Voigt A., Shalaby A., Saba S. Continued rise in rates of cardiovascular implantable device infection in the United States: temporal trends and causative insights. Pacing. Clin. Electrophysiol. 2010; 33: 414-419.Al-Khatib S.M., Lucas Jollis J.G., Malenka D.J., Wennberg D.E. The relation between patients’ outcome and the volume of cardioverter-defibrillator implantation procedures performed by physicians treating Medicare beneficiaries. J Am Coll Cardiol. 2005; 46: 1536-1540.Al-Khatib S.M., Lucas Jollis J.G., Malenka D.J., Wennberg D.E. The relation between patients’ outcome and the volume of cardioverter-defibrillator implantation procedures performed by physicians treating Medicare beneficiaries. J Am Coll Cardiol. 2005; 46: 1536-1540.Borleffs C.J.M., Thijssen J., de Bie M.K. Recurrent implantable cardioverter-defibrillator replacement is associated with an increasing risk of pocket-related complications. Pacing. Clin. Electrophysiol. 2010; 33: 1013-1019.Borleffs C.J.M., Thijssen J., de Bie M.K. Recurrent implantable cardioverter-defibrillator replacement is associated with an increasing risk of pocket-related complications. Pacing. Clin. Electrophysiol. 2010; 33: 1013-1019.Poole J.E., Gleva M.J., Mela T. REPLACE Registry Investigators Complication rates associated with pacemaker or implantable cardioverter-defibrillator replacements and upgrade procedures: results from the REPLACE registry. Circulation. 2010; 122: 1553-1561.Poole J.E., Gleva M.J., Mela T. REPLACE Registry Investigators Complication rates associated with pacemaker or implantable cardioverter-defibrillator replacements and upgrade procedures: results from the REPLACE registry. Circulation. 2010; 122: 1553-1561.Dasgupta A., Montalvo J., Medendorp S. Increased complication rates of cardiac rhythm management devices in ESRD patients. Am. J. Kidney Dis. 2007; 49: 656-663.Dasgupta A., Montalvo J., Medendorp S. Increased complication rates of cardiac rhythm management devices in ESRD patients. Am. J. Kidney Dis. 2007; 49: 656-663.Sohail M.R., Henrikson C.A., Braid-Forbes M.J. et al. Mortality and cost associated with cardiovascular implantable electronic device infections. Arch Intern Med 2011; 171: 1821–1828.Sohail M.R., Henrikson C.A., Braid-Forbes M.J. et al. Mortality and cost associated with cardiovascular implantable electronic device infections. Arch Intern Med 2011; 171: 1821–1828.Henrikson C.A., Zhang K., Brinker J.A. High mid-term mortality following successful lead extraction for infection. Pacing Clin. Electrophysiol 2011; 34: 32–36.Henrikson C.A., Zhang K., Brinker J.A. High mid-term mortality following successful lead extraction for infection. Pacing Clin. Electrophysiol 2011; 34: 32–36.Tarakji K.G., Chan E.J., Cantillon D.J. et al. Cardiac implantable electronic device infections: Presentation, management, and patient outcomes. Heart Rhythm. 2010; 7: 1043–1047.Tarakji K.G., Chan E.J., Cantillon D.J. et al. Cardiac implantable electronic device infections: Presentation, management, and patient outcomes. Heart Rhythm. 2010; 7: 1043–1047.de Bie M.K., van Rees J.B., Thijssen J. et al. Cardiac device infections are associated with a significant mortality risk. Heart Rhythm. 2012; 9: 494–498.de Bie M.K., van Rees J.B., Thijssen J. et al. Cardiac device infections are associated with a significant mortality risk. Heart Rhythm. 2012; 9: 494–498.Bloom H., Heeke B., Leon A. et al. Renal insufficiency and the risk of infection from pacemaker or defibrillator surgery. Pacing. Clin. Electrophysiol. 2006; 29: 142–145.Bloom H., Heeke B., Leon A. et al. Renal insufficiency and the risk of infection from pacemaker or defibrillator surgery. Pacing. Clin. Electrophysiol. 2006; 29: 142–145.Lekkerkerker J.C., van Nieuwkoop C., Trines S.A. et al. Risk factors and time delay associated with cardiac device infections: Leiden Device Registry. Heart. 2009; 95: 715–720.Lekkerkerker J.C., van Nieuwkoop C., Trines S.A. et al. Risk factors and time delay associated with cardiac device infections: Leiden Device Registry. Heart. 2009; 95: 715–720.Klug D., Balde M., Pavin D. et al. PEOPLE Study Group. Risk factors related to infections of implanted pacemakers and cardioverterdefibrillators: results of a large prospective study. Circulation. 2007; 116: 1349 –1355.Klug D., Balde M., Pavin D. et al. PEOPLE Study Group. Risk factors related to infections of implanted pacemakers and cardioverterdefibrillators: results of a large prospective study. Circulation. 2007; 116: 1349 –1355.Wong G.C.L., O’Toole G.A. All together now: Integrating biofilm research across disciplines. MRS Bulletin, 2011; 36: 339–342.Wong G.C.L., O’Toole G.A. All together now: Integrating biofilm research across disciplines. MRS Bulletin, 2011; 36: 339–342.Николаев Ю.А., Плакунов В.К. Биопленка — «город микробов» или аналог многоклеточного организма? Микробиология. 2007; 76(2): 149-163. Nikolaev Y.A., Plakunov V.K. Biofilm — «City of microbes» or an analogue of multicellular organisms? Microbiology. 2007; 76(2): 125-138 [in Russian].Николаев Ю.А., Плакунов В.К. Биопленка — «город микробов» или аналог многоклеточного организма? Микробиология. 2007; 76(2): 149-163. Nikolaev Y.A., Plakunov V.K. Biofilm — «City of microbes» or an analogue of multicellular organisms? Microbiology. 2007; 76(2): 125-138 [in Russian].Duval X., Selton Suty C., Alla F. еt al. Endocarditis in Patients with a Permanent Pacemaker: A 1-Year Epidemiological Survey on Infective Endocarditis due to Valvular and/or Pacemaker Infection. Clin. Infect. Dis. 2004; 39(1): 68–74.Duval X., Selton Suty C., Alla F. еt al. Endocarditis in Patients with a Permanent Pacemaker: A 1-Year Epidemiological Survey on Infective Endocarditis due to Valvular and/or Pacemaker Infection. Clin. Infect. Dis. 2004; 39(1): 68–74.Rodriguez D.J., Afzal A., Evonich R., Haines D.E. The prevalence of methicillin resistant organisms among pacemaker and defibrillator implant recipients. Am. J. Cardiovasc. Dis. 2012; 2(2): 116–122.Rodriguez D.J., Afzal A., Evonich R., Haines D.E. The prevalence of methicillin resistant organisms among pacemaker and defibrillator implant recipients. Am. J. Cardiovasc. Dis. 2012; 2(2): 116–122.Victor F., De Place C., Camus C. et al. Pacemaker lead infection: echocardiographic features, management, and outcome. Heart. 1999; 81(1): 82–87.Victor F., De Place C., Camus C. et al. Pacemaker lead infection: echocardiographic features, management, and outcome. Heart. 1999; 81(1): 82–87.Cacoub P., Leprince P., Nataf P. et al. Pacemaker infective endocarditis. Am. J. Cardiol. 1998; 82(4): 480-484.Cacoub P., Leprince P., Nataf P. et al. Pacemaker infective endocarditis. Am. J. Cardiol. 1998; 82(4): 480-484.Рекомендации Европейского общества кардиологов по веде- нию пациентов инфекционным эндокардитом 2015. Российский кардиологический журнал, 2016; 5 (133): 65-116. 2015 ESC Guidelines for the management of infective endocarditis. Russ. J. Cardiol 2016; 5(133): 65-116 [in Russian].Рекомендации Европейского общества кардиологов по веде- нию пациентов инфекционным эндокардитом 2015. Российский кардиологический журнал, 2016; 5 (133): 65-116. 2015 ESC Guidelines for the management of infective endocarditis. Russ. J. Cardiol 2016; 5(133): 65-116 [in Russian].

The authors declare that there are no conflicts of interest present.