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[Septicemia associated with the presence of a pacemaker with endocavitary electrode]
C Jacomet1, P Cacoub, D De Zuttere
1Service de Médecine Interne, Hôpital Pitié-Salpétrière, Paris.
Abstract:
Septicaemia on endovenous pacemaker electrodes is infrequent and difficult to detect. We report the case of a 64-year old woman with a diagnosis of prolonged fever that dragged on for several months before infection of her pacemaker was considered, then confirmed. Repeated Staphylococcus epidermidis isolates from blood cultures were no longer regarded as contaminations, and transoesophageal echocardiography revealed the presence of a "mass" on her endocavitary electrode, which had not been visualized on several previous échocardiographies. Surgical removal of the electrode was soon required in view of multiple septic emboli despite a bacteriologically effective antibiotic therapy. The outcome is favourable after a 6-month follow-up. The authors review the diagnostic and therapeutic problems created by infections on electrosystolic exciting electrodes.
Insights
Septicemia on endovenous pacemaker electrodes is rare and challenging to diagnose. This case highlights the importance of considering pacemaker infection in prolonged fever and the need for prompt surgical intervention for effective treatment.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Devices
Background:
- Septicemia on endovenous pacemaker electrodes is an infrequent but serious complication.
- Early detection and diagnosis of pacemaker infections pose significant challenges.
Observation:
- A 64-year-old woman presented with prolonged fever, initially undiagnosed.
- Repeated Staphylococcus epidermidis blood cultures and transesophageal echocardiography revealed a mass on the endocavitary electrode.
Findings:
- The pacemaker infection was confirmed despite initial blood culture results being considered contaminants.
- Surgical removal of the infected electrode was necessary due to multiple septic emboli, even with effective antibiotic therapy.
Implications:
- This case underscores the diagnostic difficulties and therapeutic complexities of infected pacemaker electrodes.
- Prompt recognition and management are crucial for favorable outcomes in pacemaker-related septicemia.