Gram-positive occult bacteremia in patients with pacemaker and mechanical valve prosthesis: a difficult therapeutic challenge

Abstract

Aims: In pacemaker patients with Gram-positive occult bacteremia, it is reasonable to remove the whole stimulation system, but therapeutic decision is sometimes very challenging.

Methods and results: A young patient at 6 years of age underwent dual-chamber pacemaker implantation due to complete atrioventricular block after mitral valve replacement. He felt well until November 2008, when he suffered from febrile illness with blood cultures disclosing methicillin-resistant staphylococcus aureus strain. Repeated antibiotic courses were effective only in obtaining temporary remissions. Consecutive transoesophageal echocardiography examinations were inconclusive. A labelled leucocyte scintigraphy, showing increased captation along leads, was very helpful and critical in guiding our decision to extract leads.

Conclusion: In equivocal cases, or when the hazard of extraction procedure is presumably high, every accessory diagnostic tool (like scintigraphy with labelled leucocytes) is helpful in establishing a definitive diagnosis and in strengthening a somewhat difficult decision.