心脏起搏器感染病.ppt

Pacemaker infection Case presentation
Dr. Cheuk Ming Yan, Candy
Alice Ho Miu Ling Nethersole Hospital
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Mr. Chui, 81-years-old
Presented with recurrent syncope
Holter showed sick sinus syndrome
VVI implanted in July 2005, procedure uneventful
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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
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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
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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
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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
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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
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However, patient refused lead removal because of the risk of the procedure
The pacer lead was cut short with radical sterilization done by