目的 探讨起搏器相关感染性心内膜炎的临床特点、病原学、诊断方法、治疗及预后.方法 回顾性分析1997年1月-2011年1月收治的感染性心内膜炎患者291例,其中发生起搏器相关感染性心内膜炎6例(2.1%),总结其临床表现、病原学、超声心动图结果、治疗及转归情况,并复习相关文献.结果 6例患者中男4例,女2例,平均年龄(53±8)岁.血培养阳性3例均为葡萄球菌,其中2例为耐苯唑西林的葡萄球菌;组织培养阳性2例,其中1例为真菌.6例患者经胸超声心动图检查均发现赘生物.4例患者抗感染治疗的同时行手术取出起搏器装置,随访4～19个月,无感染复发.1例单纯抗生素治疗的患者于院内死亡.1例失访.结论 葡萄球菌为起搏器相关感染性心内膜炎最常见的致病菌,且部分致病菌为耐药菌.去除起搏器装置是治疗起搏器相关感染性心内膜炎的关键,并可改善预后.初始经验性抗感染治疗应覆盖耐苯唑西林葡萄球菌的药物.%Objective To investigate the clinical features, microbiological results, diagnosis, management and prognosis of pacemaker related infective endocarditis. Methods Retrospectively reviewed 291 patients with infective endocarditis,presented to the hospital from January, 1997 to January,2011.6 patients met the definition for pacemaker related infective endocarditis. Their clinical manifestations, pathogens, echocardiographic measures, treatment and prognosis were summarized.And related literatures were reviewed. Results 6 patients include 4 males and 2 femoles,the mean age was ( 53 _+ 8 )years,Positive blood cultures were obtained in 3 cases( staphylococcus in 3 ) and oxacillin resistant staphylococci in 2 cases. Positive tissue cultures were obtained in 2 cases, fungi in 1. Vegetations were detected in all cases with transthoracic echocardiography. 4 patients were treated with combined approach of surgical guide wire removal and parenteral antibiotics, and no infection recurrence at their last visit ( time of follow up, 4 ～ 19months ). 1 patients who was only treated with parenteral antibiotics died during hospitalization. 1 case cost of followup. Conclusion Staphylococci was the most commonly isolated pathogens,and some of them are oxacillin resistant staphylococci. Completely removal of the pacemaker device was the key point to treatment ineffective endocarditis. Anti-oxacillin resistant staphylococcal therapy should be administered initially as empirical antibiotic coverage.
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