FDG PET/CT-Guided Extraction of Infected Implantable Cardioverter-Defibrillator Causing Recurrent Stenotrophomonas...

Gram-negative bacteremia rarely cause cardiac implantable electronic device infections (CIEDIs), thus challenging prompt diagnosis and device extraction.

A 57-year-old man with end-stage renal disease and an implantable cardioverter-defibrillator (ICD) for secondary prevention developed persistent Stenotrophomonas maltophilia bacteremia despite intravenous antibiotics and elimination of alternative infection sources. He had no pocket infection or echocardiographic evidence of endocarditis. Serial fluorine-18 fluorodeoxyglucose positron emission tomography combined with-computed tomography (¹⁸F-FDG PET/CT) demonstrated ICD seeding. The device was extracted, and the patient was treated with trimethoprim-sulfamethoxazole and levofloxacin, with bacteremia resolution. Results of intraoperative cultures confirmed device infection with S. maltophilia, a multidrug-resistant, biofilm-forming, gram-negative pathogen. The ICD was later reimplanted subcutaneously to lower the infection risk.

S. maltophilia is an emerging gram-negative organism that can cause CIEDI. ¹⁸F-FDG PET/CT can guide CIEDI diagnosis when a patient has occult bacteremia and uncertain device seeding.

Maintain suspicion for cardiac device involvement in S. maltophilia bacteremia and use FDG PET CT when CIEDI is unclear.