Ghazal Gaelle, Boueiz Michel, El Koubayati Georgio, Khalil Majd, Mansour Ziad, Khoury Nabil
Internal Medicine, Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon.
Cardiology Department, Lebanese Geitaoui University Medical Center, Beirut, Lebanon.
Heliyon. 2024 Nov 1;10(21):e40073. doi: 10.1016/j.heliyon.2024.e40073. eCollection 2024 Nov 15.
Cardiac implantable electronic devices (CIEDs), including pacemakers, have undeniably revolutionized the treatment of cardiac conditions. However, just like any other treatment or intervention some significant challenges can be encountered in CIEDs, mainly, CIED infections. With reported incidence rates ranging from 1 % to 15 % these infections can pose lead to dangerous complications. Our case report presents an occurrence of late-onset pacemaker endocarditis, which despite proper antibiotic therapy required an open-heart surgery as the only curative option.
Our patient is a 50-year-old female known to have a pacemaker implanted twenty years ago, she presented with fever and purulent discharge from her pacemaker site. After thorough investigations, diagnostic tests confirmed a Serratia marcescens infection and despite antibiotic treatment, the patient's symptoms persisted, an echocardiography revealed tricuspid valve involvement with vegetations. Surgical intervention, by complete removal of the old and new pacemaker leads, tricuspid valvuloplasty, and installation of an epicardial pacemaker, was performed.
Our case highlights the rarity and complexity of Serratia marcescens-related pacemaker endocarditis and all CIEDs in general, while emphasizing the importance of interdisciplinary management to optimize patient outcomes. Early diagnosis, prompt treatment, and comprehensive surgical approaches are essential in managing CIED infections and achieving successful outcomes.
包括起搏器在内的心脏植入式电子设备（CIED）无疑给心脏病的治疗带来了革命性变化。然而，与任何其他治疗或干预措施一样，CIED也会遇到一些重大挑战，主要是CIED感染。据报道，这些感染的发生率在1%至15%之间，可能导致危险的并发症。我们的病例报告展示了一例迟发性起搏器心内膜炎的发生，尽管进行了适当的抗生素治疗，但仍需要进行心脏直视手术作为唯一的治愈选择。
我们的患者是一名50岁女性，20年前植入了起搏器，她出现发热和起搏器部位有脓性分泌物。经过全面检查，诊断测试证实为粘质沙雷菌感染，尽管进行了抗生素治疗，但患者的症状仍持续存在，超声心动图显示三尖瓣受累并伴有赘生物。通过完全移除新旧起搏器导线、进行三尖瓣成形术并安装心外膜起搏器进行了手术干预。
我们的病例突出了粘质沙雷菌相关起搏器心内膜炎以及一般所有CIED的罕见性和复杂性，同时强调了跨学科管理对优化患者预后的重要性。早期诊断、及时治疗和全面的手术方法对于管理CIED感染并取得成功结果至关重要。
