299.2 🩺 國考版

299.2.1 高頻考點

299.2.1.1 Early vs Late PVE

  • Early ≀ 12 mo: nosocomial (CoNS, S. aureus, fungi, GNR)
  • Late > 12 mo: similar to NVE (viridans, S. gallolyticus, HACEK, Enterococcus)

299.2.1.2 Staph PVE Treatment

  • Nafcillin (MSSA) or vancomycin (MRSA)
    • Gentamicin × 2 wk
    • Rifampin × 6 wk (biofilm penetration crucial)

299.2.1.3 Imaging

  • TEE first-line
  • CT cardiac for paravalvular
  • FDG-PET-CT for > 3 mo post-implant
  • White cell scintigraphy alternative

299.2.1.4 Surgery in PVE

  • More aggressive than NVE
  • HF, persistent bacteremia, abscess, fungal, MDR, recurrent embolism
  • Re-do sternotomy
  • Often urgent

299.2.1.5 CIED-IE Treatment

  • Class I: complete device extraction
  • IV antibiotics × 2-6 wk
  • Re-implant after course (contralateral)
  • Sub-Q ICD or leadless pacemaker alternatives

299.2.1.6 TYRX Envelope

  • PADIT trial (2019)
  • Reduced CIED infection
  • For re-do or high-risk

299.2.2 易混淆比范

Setting Most Common Treatment Pearl
Early PVE (≀ 12 mo) CoNS, S. aureus, fungi, GNR Vanc + gent + rifampin
Late PVE (> 12 mo) Viridans, Strep gallolyticus, HACEK Per culture
Staph PVE S. aureus, CoNS Vanc + gent + rifampin
Fungal PVE Candida Echinocandin + surgery + long-term suppression
CIED infection CoNS, S. aureus Device extraction + abx + re-implant
LVAD driveline S. aureus, Pseudomonas Long-term abx + debridement
TAVR IE Similar to NVE/PVE Aggressive antibiotics, surgical decision

299.2.3 Special Topics

299.2.3.1 Subcutaneous ICD

  • For patients with high infection risk
  • No transvenous leads
  • Specific arrhythmia indications

299.2.3.2 Leadless Pacemaker (Micra)

  • For single-chamber pacing needs
  • Lower infection rate
  • Particularly useful post-CIED infection

299.2.3.3 LVAD Driveline Pearls

  • Most infections start at exit site
  • Daily site care critical
  • Skin barriers, prophylactic dressing
  • Long-term suppressive antibiotics often used