Pacemaker infection due to Aspergillus: report of two cases and literature review

Abstract

SummaryBackground: Aspergillus infections of pacing systems are extremely uncommon, and most cases reported are characterized by an aggressive behavior that may lead to death of the patient.Hypothesis: The study was undertaken to assess the incidence of pacemaker infection due to Aspergillus in a defined population.Methods: A retrospective review of the case histories of all patients who underwent pacemaker implantation in the reference center for a defined population over a 13-year period was undertaken. A literature review of pacemaker infections due to Aspergillus was conducted.Results: Of the 1,321 patients who required pacemaker implantation at Hospital Xeral-Calde in the Lugo region of northwestern Spain, 38 suffered a pacemaker infection. A pacemaker pocket infection due to Aspergillus fumigatus was found in two patients. Both patients had a previous history of diabetes mellitus. Cultures from pacemaker pocket inflammatory fluid yielded positive results. Following pacemaker explantation and antifungal therapy, clinical improvement was achieved. A literature review showed another five cases of pacemaker infection due to Aspergillus. However, two peculiarities were found in our patients: In both cases an etiological diagnosis was achieved prior to surgery and, to the best of our

A Case of Late Implantable Cardiac Device Infection with Aspergillus in an Immunocompetent Host

“…He was effectively treated with voriconazole and linezolid. In contrast, Izquierdo et al [ 7 ] described two patients who developed pocket infections secondary to A. fumigatus but almost 1.5 to 2 years after device manipulation. Like Pincus et al, their cases also had risk factors like diabetes, but eventually did well with surgical and medical treatment.…”

“…The majority of these latter cases were lead infections with a few complicated with endocarditis. Only 5 cases were reported who had a generator pocket infection [ 4 – 7 ]. Most commonly seen were the Aspergillus species with one case reporting Candida8, but all of them had chronic disease which could have caused the patient to be vulnerable to a fungal infection.…”

The importance of preventing infections related to the implantation of a cardiac implantable electronic devices in the population of Bydgoszcz

“…Methicillin-resistant Staphylococcus aureus (MRSA), constitute half of all CIED infections caused by S. aureus and are often associated with a worse prognosis [16,17]. The presence of MRSA on patients' skin is an independent risk factor for CIED infection, suggesting that infection may occur during device implantation [11,18]. Culture-negative CIED infections are a particular problem, occurring in approximately 6% to 20% of all CIED infection cases.…”

“…approximately 400 CIED infections), they may have serious consequences for the well-being of patients, and what is more, analyzes included in the INNOWO report showed that the actual cost of treating CIED infection may reach up to PLN 200,000 [38]. On average, treatment procedures for CIED-related infection bring losses of PLN 3,000 to hospitals, and each subsequent day of the patient's hospitalization results in a decline in the financial result center by an average of almost PLN 872 [18]. The INNOWO report emphasized that in the years 2016-2019 there was an increase in the costs of treating infections related to PLN 5.4 million to PLN 7.4 million.…”