Pacemaker lead infection and related bacteraemia caused by normal and small colony variant phenotypes of Bacillus licheniformis

Abstract

Here, we report what we believe to be the first case of bacteraemia with small colony variants of Bacillus licheniformis related to a pacemaker lead infection by B. licheniformis displaying the normal phenotype. Arbitrarily primed PCR analysis showed a clonal strain. The infection was cured after the removal of the infected device. Case reportA 42-year-old immunocompetent man was admitted to the Department of Cardiology of the University Hospital Münster for the treatment of pacemaker lead (PL) infection. Fourteen years previously, the patient had undergone mitral valve replacement with an artificial mechanical valve (TEKNA, size 27 mm) after the removal of a papillary fibroelastoma. Due to a post-operative third degree atrioventricular block, a dual-chamber pacemaker (MDT Kappa 401 DR, Medtronic) had been implanted on the right side of the chest. Eight years later, at the age of 36, a left-sided reimplantation of a dual-chamber pacemaker (Biotronik Axios DR, Biotronik) with right atrial (Medtronic CapSureFix 5076, Medtronic) and right ventricular PLs (Biotronik Merox 60-15 BP) became necessary because of PL dysfunction. The old right-sided pacemaker and PL were removed. Three years following reimplantation (i.e. 3 years prior to the present hospitalization), the patient was admitted with sepsis, and Bacillus licheniformis was identified in five blood cultures. This was preceded by recurrent pneumonia over 6 months and a 12 kg weight loss. A transoesophageal echocardiogram (TOE) showed no evidence of cardiac infection at that time, and positron emission tomography/computed tomography revealed multiple pulmonary densities.Following antibiotic therapy with amoxicillin/clavulanic acid and gentamicin, laboratory parameters normalized and the patient clinically recovered. Three months prior to the present admission, a partial right-lung lobectomy was performed in another hospital after the radiological detection of lung lesions, and the histopathology showed multiple segmental pulmonary embolism. At that time, several TOEs remained non-diagnostic with regard to infective endocarditis (IE).Upon the present admission, the patient reported decreased functional capacity during the last 3 years. He suffered from frequent night sweats, orthostatic dizziness and recurrent pulmonary infections. The patient had a reduced general condition. Upon admission, his C-reactive protein level was 52 mg l 21 and the level of leukocytes was 6840 ml 21 . A TOE revealed a vegetation near the right ventricular PL. Before the initiation of antimicrobial treatment, peripheral blood cultures were collected and three sets grew B. licheniformis. Vancomycin and ceftriaxone therapy was initiated. After identification and antimicrobial susceptibility testing, antibiotic therapy was changed to intravenous amoxicillin/clavulanic acid. The pacemaker and the PLs were removed, and B. licheniformis was also isolated from both atrial and ventricular PLs. At the same time, a new pacemaker (Medtronic Relia SR RESR01) was placed in an abdominal position usi...

The Cooperative and Interdependent Roles of GerA, GerK, and Ynd in Germination of Bacillus licheniformis Spores

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Aging Might Increase the Incidence of Infection from Permanent Pacemaker Implantation

“…One of the most feared complications of device placement is infection, which can be associated with substantial morbidity and mortality. Infection rates for these devices reportedly vary from 0.7% to 7.0% [8, 9, 11–13] with a resultant 3.1-fold increase in the number of associated hospitalizations in recent years [13, 14]. Mortality rates attributable to infection have ranged from 2.6% to 3.3% [13–16].…”

“…Additionally, implantation-induced infection is the most serious complication of this kind of treatment [8, 9]. …”

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