Atypical pathogens associated with cardiac implantable electronic device infections

Abstract

Background Cardiovascular implantable electronic device (CIED) infections are associated with significant morbidity and mortality making the identification of the causative organism critical. The vast majority of CIED infections are caused by Staphylococcal species. CIED infections associated with atypical pathogens are rare and have not been systematically investigated. The objective of this study is to characterize the clinical course, management and outcome in patients with CIED infection secondary to atypical pathogens. Methods Medical records of all patients who underwent CIED system extraction at the University of Chicago Medical Center between January 2010 and November 2020 were retrospectively reviewed to identify patients with CIED infection. Demographic, clinical, infection‐related and outcome data were collected. CIED infections were divided into typical and atypical groups based on the pathogens isolated. Results Among 356 CIED extraction procedures, 130 (37%) were performed for CIED infection. Atypical pathogens were found in 5.4% (n = 7) and included Pantoea species (n = 2), Kocuria species (n = 1), Cutibacterium acnes (n = 1), Corynebacterium tuberculostearicum (n = 1), Corynebacterium striatum (n = 1), Stenotrophomonas maltophilia (n = 1), and Pseudozyma ahidis (n = 1). All patients with atypical CIED infections were successfully treated with total system removal and tailored antibiotic therapy. There were no infection‐related deaths. Conclusions CIED infections with atypical pathogens were rare and associated with good outcome if diagnosed early and treated with total system removal and tailored antimicrobial therapy. Atypical pathogens cultured from blood, tissue or hardware in patients with CIED infection should be considered pathogens and not contaminants.

Infection or Contamination with Rothia, Kocuria, Arthrobacter and Pseudoglutamicibacter— a Retrospective Observational Study of Non- Micrococcus Micrococcaceae in the Clinic

“…Regarding the identification of the studied bacteria in locations other than blood, seven cases with true infection were found, including septic arthritis caused by R. mucilaginosa and arthritis, peritonitis, and pacemaker infection caused by Kocuria spp. Except for Kocuria peritonitis, these infections have previously been identified although only published in a few case reports, with each making these findings among the first published ( 30 – 34 ). The adjustments for pediatric blood cultures and for infections outside the bloodstream are somewhat less robust than the ones used for adults with bloodstream infection.…”

Un germen inesperado: presentación atípica de infección de bolsillo de dispositivo de estimulación cardiaca por Vagococcus fluvialis

“…They are recognized as pathogens when there are two positive blood cultures or tissue or electrode cultures with the growth of said microorganism. 5 Infection by such atypical germs usually evolves favorably and responds well to directed antibiotic treatment and removal of the device.…”

“…Atypical microorganisms, such as Vagococcus fluvialis, have a different clinical course, from slowly developing infections to rapidly progressive courses. 5…”

New advances in management and treatment of cardiac implantable electronic devices infections

“…Finally, CDIs caused by atypical pathogens (infection due pathogens rarely or previously not associated with CDIs in humans) were rare but when isolated from blood, tissue, or hardware in patients with CDIs, these pathogens should be considered as etiology of infection and not contaminants considering the crucial role of early diagnosis and targeted treatment. A recent US single-center retrospective analysis of CDIs episodes between 2010 and 2020 found atypical pathogens (i.e., Corynebacterium striatum and Stenotrophomonas maltophilia ) in 5.4% of all CDIs [ 23 ].…”