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Staphylococcus simulans bloodstream infection following CIED extraction
John Raymond Go1, Cristina Corsini Campioli1, Daniel DeSimone1
1Division of Infectious Disease, Mayo Clinic Minnesota, Rochester, Minnesota, USA.
Insights
An elderly patient with an implantable cardioverter-defibrillator (ICD) developed a severe infection with Staphylococcus bacteria after a device extraction. Despite treatment, the patient experienced septic shock and ultimately expired.
Area of Science:
- Infectious Diseases
- Cardiology
- Medical Device Infections
Background:
- A 78-year-old male with a history of heart failure and complete heart block had an implantable cardioverter-defibrillator (ICD).
- The patient presented with symptoms of infection, including chills and malaise, and an open wound over the ICD site.
Observation:
- Initial blood cultures were negative, and transesophageal echocardiogram showed no vegetations.
- The patient underwent a prolonged ICD extraction procedure.
Findings:
- Postoperatively, the patient developed septic shock.
- Device and blood cultures identified Staphylococcus simulans and Staphylococcus epidermidis.
- Treatment with vancomycin was ineffective, leading to refractory hypotension and multiorgan failure.
Implications:
- This case highlights the risk of device-related infections, even with coagulase-negative Staphylococci.
- Potential environmental acquisition of Staphylococcus simulans from farm animals is suggested.
- Prolonged device extraction procedures may increase the risk of bacteremia.
Abstract:
A 78-year-old man with an implantable cardioverter-defibrillator (ICD) presented with chills and malaise. His history was significant for heart failure with reduced ejection fraction and complete heart block. He had undergone permanent pacemaker placement that was later upgraded to an ICD 5 years before his presentation. Physical examination revealed an open wound with surrounding erythema overlying the device site. Blood cultures obtained on admission were negative. Transesophageal echocardiogram did not show valve or lead vegetations. He underwent a prolonged extraction procedure. Postoperatively, he developed septic shock and cultures from the device, and repeat peripheral blood cultures grew Staphylococcus simulans and Staphylococcus epidermidis He was treated with intravenous vancomycin but had refractory hypotension, leading to multiorgan failure. He later expired after being transitioned to comfort care. The patient may have acquired S. simulans by feeding cows on a nearby farm, and the prolonged extraction procedure may have precipitated the bacteraemia.
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