Division of Infectious Disease, Mayo Clinic Minnesota, Rochester, Minnesota, USA.
Division of Infectious Disease, Mayo Clinic Minnesota, Rochester, Minnesota, USA
BMJ Case Rep. 2021 May 27;14(5):e240309. doi: 10.1136/bcr-2020-240309.
A 78-year-old man with an implantable cardioverter-defibrillator (ICD) presented with chills and malaise. His history was significant for heart failure with reduced ejection fraction and complete heart block. He had undergone permanent pacemaker placement that was later upgraded to an ICD 5 years before his presentation. Physical examination revealed an open wound with surrounding erythema overlying the device site. Blood cultures obtained on admission were negative. Transesophageal echocardiogram did not show valve or lead vegetations. He underwent a prolonged extraction procedure. Postoperatively, he developed septic shock and cultures from the device, and repeat peripheral blood cultures grew and He was treated with intravenous vancomycin but had refractory hypotension, leading to multiorgan failure. He later expired after being transitioned to comfort care. The patient may have acquired by feeding cows on a nearby farm, and the prolonged extraction procedure may have precipitated the bacteraemia.
一位 78 岁男性，患有植入式心脏复律除颤器（ICD），出现寒战和不适。他的病史包括射血分数降低性心力衰竭和完全性心脏阻滞。他曾接受过永久性起搏器植入术，5 年前升级为 ICD。体格检查显示设备部位有开放性伤口，周围红斑。入院时采集的血培养结果为阴性。经食管超声心动图未显示瓣膜或导线赘生物。他接受了长时间的取出手术。术后，他出现感染性休克，设备和重复外周血培养均生长出 和 。他接受了静脉万古霉素治疗，但血压仍难以控制，导致多器官衰竭。后来，他在转入舒适护理后去世。患者可能在附近农场放牛时感染了 ，长时间的取出手术可能引发了菌血症。
