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Comba IY, Chesdachai S, Tabaja H, Mahmood M, Deml S, Wengenack NL, Wilson JW. Cardiovascular device infections due to rapidly growing Mycobacteria: A review of cases at a tertiary care hospital. J Clin Tuberc Other Mycobact Dis 2022; 26:100296. [PMID: 35059507 PMCID: PMC8760459 DOI: 10.1016/j.jctube.2022.100296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Cardiovascular device infection due to rapidly growing mycobacteria (RGM) is rarely encountered in clinical practice. Due to the increasing number of indications and use of cardiovascular devices in an aging population, optimized management of these infections is of great importance. We report seven cases of RGM cardiovascular device infection. Three patients had left-ventricular assist device (LVAD) infections; two patients had cardiovascular implantable device (CIED) infections; and one had an aortic vascular stent infection. Specific cardiac valvular infection was not detected among any of the patients. All patients had a high number of comorbidities which limited some patients from receiving optimal combination antimicrobial therapy. The prognosis of cardiovascular device infections with RGM is guarded with only four patients still alive; however, the treatment approach for each patient varied considerably and often based on concurrent medical conditions, overall adjustments to goals of care, and specific patient preferences. Further analysis of cardiovascular device infections with RGM is warranted to establish a more systematic approach in successful management.
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Affiliation(s)
- Isin Yagmur Comba
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Corresponding author at: Division of Infectious Diseases, Department of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
| | - Supavit Chesdachai
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Hussam Tabaja
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Maryam Mahmood
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sharon Deml
- Division of Clinical Microbiology, Department of Laboratory Medicine, Mayo Clinic, Rochester, MN, USA
| | - Nancy L. Wengenack
- Division of Clinical Microbiology, Department of Laboratory Medicine, Mayo Clinic, Rochester, MN, USA
| | - John W. Wilson
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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Zhu J, Yang Q, Pan J, Shi H, Jin B, Chen Q. Cardiac resynchronization therapy-defibrillator pocket infection caused by Mycobacterium fortuitum: a case report and review of the literature. BMC Cardiovasc Disord 2019; 19:53. [PMID: 30836955 PMCID: PMC6402086 DOI: 10.1186/s12872-019-1028-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 02/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With the rising utilization of cardiovascular implantable electronic devices (CIEDs), infections secondary to device implantation are increasingly encountered. Staphylococcus aureus and coagulase-negative staphylococci are usually the predominant causative organisms. A CIED infection due to non-tuberculous mycobacteria (NTM) is extremely rare. CASE PRESENTATION A 68-year-old man was admitted to our hospital with a history of pain and swelling at his cardiac resynchronization therapy-defibrillator (CRT-D) pocket site, for 4 days. The CRT-D had been implanted 2 weeks prior. The exudate smear was positive for acid-fast bacilli and culture results revealed rapidly growing nontuberculous mycobacteria (RGM). After an urgent removal of the device followed by 1 year of antibiotic treatment, the patient was completely cured. A new device was finally implanted, 3 years later. CONCLUSIONS Infections caused by nontuberculous mycobacteria following the implantation of cardiac devices are very rare. The typical manifestations of post-implantation CIED infections caused by RGMs include an early onset, with local redness, swelling, and spontaneous drainage. Systemic symptoms such as fever, chills, and fatigue are absent. Mycobacterium fortuitum is the most common species of RGM implicated in CIED infections, the manifestations of which usually appear within several weeks of the implantation procedure. An urgent removal of the device and appropriate antibiotic therapy are essential therapeutic measures. This is the first such reported case, in which the patient has been re-implanted with another device at the same site, after achieving a complete cure. We followed-up the patient for an additional 3 years and observed that the patient remained free of infection. Our case report shows that though an RGM infection is rare and difficult to treat, it can be completely cured. In addition, we demonstrated that it is subsequently possible to safely re-implant a CIED for the patient, at the same site.
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Affiliation(s)
- Jun Zhu
- Department of Cardiology, Huashan Hospital of Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Qingluan Yang
- Department of infectious Diseases, Huashan Hospital of Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Junjie Pan
- Department of Cardiology, Huashan Hospital of Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Haiming Shi
- Department of Cardiology, Huashan Hospital of Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Bo Jin
- Department of Cardiology, Huashan Hospital of Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China.
| | - Qiying Chen
- Department of Cardiology, Huashan Hospital of Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China.
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Koutentakis M, Siminelakis S, Korantzopoulos P, Petrou A, Petrou A, Priavali H, Priavali E, Mpakas A, Gesouli H, Gesouli E, Apostolakis E, Apostolakis E, Tsakiridis K, Zarogoulidis P, Katsikogiannis N, Kougioumtzi I, Machairiotis N, Tsiouda T, Zarogoulidis K. Surgical management of cardiac implantable electronic device infections. J Thorac Dis 2014; 6 Suppl 1:S173-9. [PMID: 24672692 DOI: 10.3978/j.issn.2072-1439.2013.10.23] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Accepted: 10/29/2013] [Indexed: 12/31/2022]
Abstract
PURPOSE The infection of cardiac implantable electronic devices (CIED) is a serious and potentially lethal complication. The population at risk is growing, as the device implantation is increasing especially in older patients with associated comorbid conditions. Our purpose was to present the management of this complicated surgical condition and to extract the relevant conclusions. METHODS During a 3-year period 1,508 CIED were implanted in our hospital. We treated six cases of permanent pacemaker infection with localized pocket infection or endocarditis. In accordance to the recent AHA/ACC guidelines, complete device removal was decided in all cases. The devices were removed under general anaesthesia, with a midline sternotomy, under extracorporeal circulation on the beating heart. Epicardial permanent pacing electrodes were placed on the right atrium and ventricle before the end of the procedure. RESULTS The postoperative course of all patients was uncomplicated and after a follow up period of five years no relapse of infection occurred. CONCLUSIONS Management protocols that include complete device removal are the only effective measure for the eradication of CIED infections. Although newer technologies have emerged and specialized techniques of percutaneous device removal have been developed, the surgical alternative to these methods can be a safe solution in cases of infected devices.
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Affiliation(s)
- Michael Koutentakis
- 1 Department of Cardiothoracic Surgery, 2 Department of Cardiology, 3 Department of Anesthesiology, 4 Department of Microbiology, University Hospital Ioannina, 45500, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 8 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece
| | - Stavros Siminelakis
- 1 Department of Cardiothoracic Surgery, 2 Department of Cardiology, 3 Department of Anesthesiology, 4 Department of Microbiology, University Hospital Ioannina, 45500, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 8 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece
| | - Panagiotis Korantzopoulos
- 1 Department of Cardiothoracic Surgery, 2 Department of Cardiology, 3 Department of Anesthesiology, 4 Department of Microbiology, University Hospital Ioannina, 45500, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 8 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece
| | - Anastasios Petrou
- 1 Department of Cardiothoracic Surgery, 2 Department of Cardiology, 3 Department of Anesthesiology, 4 Department of Microbiology, University Hospital Ioannina, 45500, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 8 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece
| | | | - Helen Priavali
- 1 Department of Cardiothoracic Surgery, 2 Department of Cardiology, 3 Department of Anesthesiology, 4 Department of Microbiology, University Hospital Ioannina, 45500, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 8 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece
| | | | - Andreas Mpakas
- 1 Department of Cardiothoracic Surgery, 2 Department of Cardiology, 3 Department of Anesthesiology, 4 Department of Microbiology, University Hospital Ioannina, 45500, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 8 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece
| | - Helen Gesouli
- 1 Department of Cardiothoracic Surgery, 2 Department of Cardiology, 3 Department of Anesthesiology, 4 Department of Microbiology, University Hospital Ioannina, 45500, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 8 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece
| | | | - Efstratios Apostolakis
- 1 Department of Cardiothoracic Surgery, 2 Department of Cardiology, 3 Department of Anesthesiology, 4 Department of Microbiology, University Hospital Ioannina, 45500, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 8 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece
| | | | - Kosmas Tsakiridis
- 1 Department of Cardiothoracic Surgery, 2 Department of Cardiology, 3 Department of Anesthesiology, 4 Department of Microbiology, University Hospital Ioannina, 45500, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 8 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece
| | - Paul Zarogoulidis
- 1 Department of Cardiothoracic Surgery, 2 Department of Cardiology, 3 Department of Anesthesiology, 4 Department of Microbiology, University Hospital Ioannina, 45500, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 8 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece
| | - Nikolaos Katsikogiannis
- 1 Department of Cardiothoracic Surgery, 2 Department of Cardiology, 3 Department of Anesthesiology, 4 Department of Microbiology, University Hospital Ioannina, 45500, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 8 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece
| | - Ioanna Kougioumtzi
- 1 Department of Cardiothoracic Surgery, 2 Department of Cardiology, 3 Department of Anesthesiology, 4 Department of Microbiology, University Hospital Ioannina, 45500, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 8 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece
| | - Nikolaos Machairiotis
- 1 Department of Cardiothoracic Surgery, 2 Department of Cardiology, 3 Department of Anesthesiology, 4 Department of Microbiology, University Hospital Ioannina, 45500, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 8 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece
| | - Theodora Tsiouda
- 1 Department of Cardiothoracic Surgery, 2 Department of Cardiology, 3 Department of Anesthesiology, 4 Department of Microbiology, University Hospital Ioannina, 45500, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 8 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece
| | - Konstantinos Zarogoulidis
- 1 Department of Cardiothoracic Surgery, 2 Department of Cardiology, 3 Department of Anesthesiology, 4 Department of Microbiology, University Hospital Ioannina, 45500, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 8 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece
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Marchandin H, Battistella P, Calvet B, Darbas H, Frapier JM, Jean-Pierre H, Parer S, Jumas-Bilak E, Van de Perre P, Godreuil S. Pacemaker surgical site infection caused by Mycobacterium goodii. J Med Microbiol 2009; 58:517-520. [DOI: 10.1099/jmm.0.006759-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We describe what we believe to be the first documented case of Mycobacterium goodii infection in Europe. It is also the second documented report of a pacemaker pocket surgical site infection caused by M. goodii. Although rarely involved in such infections, rapidly growing mycobacteria should be recognized during conventional bacteriological investigations and further identified by molecular tools to provide adequate therapy. In the present case, antimicrobial therapy with doxycycline without removal of the pacemaker was successful.
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Affiliation(s)
- Hélène Marchandin
- Université Montpellier 1, EA3755, Faculté de Pharmacie, Laboratoire de Bactériologie-Virologie, F-34060 Montpellier, France
- Centre Hospitalier et Universitaire de Montpellier, Laboratoire de Bactériologie, F-34295 Montpellier, France
| | - Pascal Battistella
- Centre Hospitalier et Universitaire de Montpellier, Service de Chirurgie Thoracique et Cardio-Vasculaire, F-34295 Montpellier, France
| | - Brigitte Calvet
- Centre Hospitalier et Universitaire de Montpellier, Service de Chirurgie Thoracique et Cardio-Vasculaire, F-34295 Montpellier, France
| | - Hélène Darbas
- Centre Hospitalier et Universitaire de Montpellier, Laboratoire de Bactériologie, F-34295 Montpellier, France
| | - Jean-Marc Frapier
- Centre Hospitalier et Universitaire de Montpellier, Service de Chirurgie Thoracique et Cardio-Vasculaire, F-34295 Montpellier, France
| | - Hélène Jean-Pierre
- Université Montpellier 1, EA3755, Faculté de Pharmacie, Laboratoire de Bactériologie-Virologie, F-34060 Montpellier, France
- Centre Hospitalier et Universitaire de Montpellier, Laboratoire de Bactériologie, F-34295 Montpellier, France
| | - Sylvie Parer
- Centre Hospitalier et Universitaire de Montpellier, Service d'Hygiène Hospitalière, F-34295 Montpellier, France
| | - Estelle Jumas-Bilak
- Université Montpellier 1, EA3755, Faculté de Pharmacie, Laboratoire de Bactériologie-Virologie, F-34060 Montpellier, France
| | - Philippe Van de Perre
- Université Montpellier 1, EA 4205, F-34000 Montpellier, France
- Centre Hospitalier et Universitaire de Montpellier, Laboratoire de Bactériologie, F-34295 Montpellier, France
| | - Sylvain Godreuil
- Université Montpellier 1, EA 4205, F-34000 Montpellier, France
- Centre Hospitalier et Universitaire de Montpellier, Laboratoire de Bactériologie, F-34295 Montpellier, France
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