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Dietzia species pacemaker pocket infection: an unusual organism in human infections

Sarah Perkin1, Anne Wilson, David Walker

  • 1Cardiology Department, Conquest Hospital, St Leonards-on-Sea, East Sussex, UK.

BMJ Case Reports
|September 18, 2012
PubMed

Insights

A rare Dietzia infection caused pacemaker pocket inflammation. Prompt diagnosis using 16S rDNA PCR and explantation led to full recovery.

Area of Science:

  • Medical Microbiology
  • Infectious Diseases
  • Cardiology

Background:

  • Permanent pacemaker insertion is a common procedure for cardiac rhythm management.
  • Infections associated with cardiac implantable electronic devices (CIEDs) can be challenging to diagnose and treat.
  • Staphylococcal infections are the most commonly suspected pathogens in CIED infections.

Observation:

  • An 87-year-old male presented with recurrent cellulitis-like inflammation around his permanent pacemaker site.
  • Initial treatment with oral and intravenous flucloxacillin showed temporary improvement, but infection recurred upon cessation.
  • Standard microbiological cultures of aspirated fluid from the pacemaker site yielded no bacterial growth.

Findings:

  • 16S rDNA PCR analysis of pacemaker site fluid detected Dietzia species in both samples.
  • Dietzia species, an Actinomyces-like organism, is rarely associated with human infections.
  • This case suggests Dietzia species as a potential, albeit uncommon, cause of CIED infection.

Implications:

  • 16S rDNA PCR is a valuable tool for diagnosing CIED infections when routine cultures are negative.
  • Early identification of unusual pathogens like Dietzia species is crucial for effective treatment.
  • Management may involve device explantation, debridement, and prolonged antibiotic therapy.

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