Mycobacterium chelonae, an ‘atypical’ cause of an LVAD driveline infection

Abstract

We describe the first patient with a left ventricular assist device (LVAD) driveline infection caused by Mycobacterium chelonae presenting with persistent infection despite conventional antibiotics. Treatment was successful with surgical debridement, driveline exit relocation, and a 4-month period of antibiotics. In the case of a culture-negative LVAD driveline infection, non-tuberculous mycobacteria should be considered. This case illustrates that multidisciplinary collaboration is essential in providing optimal care for LVAD patients.

Nontuberculous mycobacterial infections in left ventricular assist device patients

“…When comparing our case's presentation to other reports of NTM infections in LVAD patients, we note that other reported cases of Mycobacterium chelonae, Mycobacterium abscessus, and Mycobacterium chimaera were also afebrile upon initial presentation. [4][5][6] Both M. chimaera cases lacked leukocytosis, similar to our case. 6 Only the Mycobacterium intracellulare case is reported to have had mild fever (37.7°C) upon presentation, and disseminated disease was later confirmed with positive culture results and imaging studies.…”

“…When comparing our case's presentation to other reports of NTM infections in LVAD patients, we note that other reported cases of Mycobacterium chelonae, Mycobacterium abscessus , and Mycobacterium chimaera were also afebrile upon initial presentation 4‐6 . Both M. chimaera cases lacked leukocytosis, similar to our case 6 .…”

“…Overall, 75% of the cases required surgical intervention, with half requiring debridement 4‐6 . More aggressive approaches to managing NTM infections in LVAD patients may be warranted given that rapidly growing mycobacteria are adept at forming biofilms 9 .…”

“…and Gram-negative bacteria cause most DLIs, 3 but DLIs caused by nontuberculous mycobacterial (NTM) species have recently been reported. [4][5][6][7] We present the second-ever reported case of a DLI caused by Mycobacterium fortuitum in a 75-year-old male with a continuous-flow LVAD. After receiving triple antimycobacterial coverage, he underwent device exchange and ultimately died after failing to recover neurologically.…”

“…Staphylococcal spp. and Gram‐negative bacteria cause most DLIs, 3 but DLIs caused by nontuberculous mycobacterial (NTM) species have recently been reported 4‐7 …”