Mayo Clinic Alix School of Medicine, Rochester, MN 55905, USA.
Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA.
Medicina (Kaunas). 2022 Feb 17;58(2):307. doi: 10.3390/medicina58020307.
Cardiac implantable electronic device (CIED) infections present a growing problem in medicine due to a significant increase in the number of implanted devices and the age of the recipient population. spp. are Gram-positive, facultative anaerobic, lactic acid bacteria; they are relatively common pathogens in humans, but uncommon as the cause of CIED lead infections. Only eight cases of endocarditis have been reported in the literature thus far; however, there are no reported cases of CIED lead infection. A 58-year-old gentleman with a previously implanted St. Jude Medical single-chamber implantable cardioverter-defibrillator (ICD) due to tachy/brady arrhythmias presented with nonspecific constitutional symptoms (i.e., low-grade fevers, chills, fatigue), and was found to have innumerable bilateral pulmonary nodules via computed tomography angiography of the chest. Many of these pulmonary nodules were cavitated and highly concerning for septic pulmonary emboli and infarcts. Within 24 h from presentation, blood cultures in all four culture bottles grew ampicillin- and vancomycin-susceptible . Transthoracic echocardiogram confirmed vegetations on the ICD lead in the right ventricle. The patient underwent laser extraction of the ICD lead with generator removal and recovered completely after a 6-week intravenous antibiotic course. To our knowledge, this is the first report of CIED lead infection caused by . In this case, management with antibiotics along with ICD lead extraction led to complete recovery. Clinicians should be aware of this rare but potentially devastating infection in patients with native and artificial valves, but also in those with CIEDs.
心脏植入式电子设备 (CIED) 感染是医学领域日益严重的问题，这主要是由于植入设备数量的增加和受者人群的年龄增长。 spp. 是革兰氏阳性、兼性厌氧、乳酸细菌；它们是人身上相对常见的病原体，但作为 CIED 导线感染的原因并不常见。迄今为止，文献中仅报道了 8 例心内膜炎病例；然而，没有报告的 CIED 导线感染病例。一名 58 岁男性，因心动过速/心动过缓心律失常先前植入了圣犹达医疗单腔植入式心脏复律除颤器 (ICD)，出现非特异性全身症状（即低热、寒战、疲劳），胸部计算机断层血管造影发现无数双侧肺结节。这些肺结节中的许多有空洞，高度怀疑为脓毒性肺栓塞和梗死。从就诊到 24 小时内，四个培养瓶中的血液培养均培养出对氨苄西林和万古霉素敏感的 。经胸超声心动图证实右心室 ICD 导线上有赘生物。患者接受了 ICD 导线的激光提取和发电机移除，在接受 6 周静脉抗生素治疗后完全康复。据我们所知，这是首例由 引起的 CIED 导线感染报告。在这种情况下，抗生素治疗加上 ICD 导线提取导致完全康复。临床医生应意识到这种在天然和人工瓣膜患者以及 CIED 患者中罕见但潜在破坏性的感染。
