Patient Report and Review of Rapidly Growing Mycobacterial Infection after Cardiac Device Implantation

Abstract

Mycobacterial infections resulting from cardiac implantable electronic devices are rare, but as more devices are implanted, these organisms are increasingly emerging as causes of early-onset infections. We report a patient with an implantable cardioverter-defibrillator pocket and associated bloodstream infection caused by an organism of the Mycobacterium fortuitum group, and we review the literature regarding mycobacterial infections resulting from cardiac device implantations. Thirty-two such infections have been previously described; most (70%) were caused by rapidly growing species, of which M. fortuitum group species were predominant.When managing such infections, clinicians should consider the potential need for extended incubation of routine cultures or dedicated mycobacterial cultures for accurate diagnosis; combination antimicrobial drug therapy, even for isolates that appear to be macrolide susceptible, because of the potential for inducible resistance to this drug class; and the arrhythmogenicity of the antimicrobial drugs traditionally recommended for infections caused by these organisms.

Keywords: Implantable cardioverter-defibrillator; Mycobacterium fortuitum group; bacteria; bloodstream infections; cardiac pacemaker; nontuberculous mycobacteria; rapidly growing mycobacteria; tuberculosis and other mycobacteria.

Figure

Photographs of the cardiac implantable electronic device pocket site for a 60-year-old man in whom infection developed at the implantation site of a cardiac implantable electronic device, Atlanta, Georgia, USA. A) Device pocket site after explantation. The wound was closed with pledged Ethibond sutures (Ethicon, Somerville, NJ, USA), and a Jackson-Pratt drain (closed-suction drainage system consisting of an internal drain connected by plastic tubing to a flexible bulb) was tunneled into the inferior aspect of the pocket. The drain was removed 24 hours postoperatively, and a small incision was left open to heal by secondary intention. B) Device pocket site 6 weeks after suture removal. Most of the incision healed well, with evidence of localized dehiscence (i.e., spontaneous partial separation of the surgical incision along the suture lines).