Skip directly to page options Skip directly to A-Z link
Volume 22, Number 3—March 2016
CME ACTIVITY - Synopsis

Patient Report and Review of Rapidly Growing Mycobacterial Infection after Cardiac Device Implantation

Varun K. PhadkeComments to Author , David S. Hirsh, and Neela D. Goswami
Author affiliations: Emory University, Atlanta, Georgia, USA

Main Article

Table 2

Clinical and demographic information for published cases of cardiac device infections due to rapidly growing mycobacteria*

Year (ref) Age, y/
sex Organism Type Onset† Bacteremia/
lead infection‡ IE§ Macrolide resistant Device removed Antimicrobial drug therapy Outcome
Mycobacterium fortuitum group
1998 (6) 74/M M. fortuitum + M. chelonae PPM 13 d NR/NR NR NR Yes FQ + AG × 4 wk Cured
2005 (9) 62/F M. fortuitum PPM 6 mo Yes/yes Yes No Yes CLR + CIP × 4 wk, DOX + CIP × 24 wk Cured
2005 (10) 74/M M. peregrinum ICD 6 wk Yes/NR NR No Yes CLR + CIP × 6 wk Cured
2005 (8) 72/M M. fortuitum PPM 2 wk No/NR No Yes Yes CIP + AG × 2 wk, CIP × 6 mo Cured
61/M M. fortuitum ICD 17 mo No/yes No Yes Yes LVX × >1 y¶ Cured
2006 (11) 80/M M. fortuitum PPM 18 d Yes/NA No No No CLR + CIP × 6 wk Cured
2007 (13) 84/F M. fortuitum PPM 1 mo No/no No Yes Yes LVX × 3 mo Cured
2007 (15) 78/F M. fortuitum PPM 3 mo Yes/yes No NR Yes CLR + LVX + LZD × 2 wk, CLR + LVX × 6 mo Cured
2007 (16) 78/F M. fortuitum PPM <4 mo Yes/NR NR NR Yes CLR + LVX + LZD × 2 wk, CLR + LVX × 22 wk Cured
77/F M. mageritense PPM 3 wk NR/NA NR NR No FQ × 6 mo Cured
2009 (18) 15/F M. fortuitum PPM 7 wk Yes/yes No No Yes CLR + CIP × 6 mo Cured
2010 (20) 78/M M. fortuitum PPM NR Yes/NR NR NR Yes CLR + CIP × 26 wk Cured
2012 (23) 43/M M. fortuitum ICD 4 y Yes/yes Yes No Yes CLR + CIP + AG Died
2012 (22) 75/M M. peregrinum PPM 1 y Yes/yes No NR Yes CLR + CIP × mo Cured
2015#
60/M
 M. fortuitum group
 ICD
 6 wk
 Yes/no
 No
 Yes
 Yes
 CLR + CIP + FOX
 Died
M. abscessus complex
1998 (5) 68/M M. abscessus PPM 19 y NR/yes NR No Yes CLR + AG + FOX × 5 wk Died
2005 (7) 53/M M. abscessus ICD 2 wk NR/NR NR Yes Yes CLR × 24 wk Cured
2007 (14)
 43/F
 M. massiliense
 PPM
 11 mo
 NR/yes
 NR
 No
 Yes
 CLR × 6 mo
 Cured
M. smegmatis complex
2006 (12) 86/M M. goodii PPM 16 d Yes/NR NR NR Yes Multiple, ending with MIN + AG × 2 wk Cured
2008 (17) 85/M M. goodii ICD <7 d No/NR No NR Yes TMP/SXT × 8 wk Cured
2009 (19)
 23/M
 M. goodii
 PPM
 8 d
 No/NA
 No
 Yes
 No
 DOX + FQ × 6 mo
 Cured
M. chelonae complex
2014 (24)
 63/M
 M. chelonae
 PPM
 NR
 No/yes
 Yes
 NR
 Yes
 CLR + LVX + AG × >2 mo
 Cured
Ungrouped rapidly growing species
2011 (21) 73/M M. phlei ICD 1 mo No/NR NR No Yes SXT + DOX × 12 mo Cured

*AG, aminoglycoside; CIP, ciprofloxacin; CLR, clarithromycin; DOX, doxycycline; FOX, cefoxitin; FQ, fluoroquinolone other than CIP or LVX; ICD, implantable cardioverter-defibrillator; IE, infective endocarditis; LVX, levofloxacin; LZD, linezolid; MIN, minocycline; NA, not available; NR, not reported; PPM, permanent pacemaker; ref, reference; TMP/SXT, trimethoprim/sulfamethoxazole.
†Time since most recent device manipulation.
‡Defined as positive lead culture, acid fast stain, or presumptive diagnosis on the basis of imaging or operative findings.
§Transthoracic or transesophageal echocardiographic findings as defined by the Duke criteria (25).
¶No end date for therapy was specified, but patient had at least 1 year of treatment.
#The patient described in this article.

Main Article

References
  1. Uslan  DZ, Sohail  MR, St Sauver  JL, Friedman  PA, Hayes  DL, Stoner  SM, Permanent pacemaker and implantable cardioverter defibrillator infection: a population-based study. Arch Intern Med. 2007;167:669–75. DOIPubMedGoogle Scholar
  2. Clinical and Laboratory Standards Institute. Susceptibility testing of mycobacteria, nocardiae, and other aerobic actinomycetes; approved standard. CLSI Document M24–A2. Wayne (PA); 2011.
  3. Brown-Elliott  BA, Wallace  RJ Jr. Clinical and taxonomic status of pathogenic nonpigmented or late-pigmenting rapidly growing mycobacteria. Clin Microbiol Rev. 2002;15:716–46. DOIPubMedGoogle Scholar
  4. von Graevenitz  A, Punter-Streit  V. Failure to recognize rapidly growing mycobacteria in a proficiency testing sample without specific request—a wider diagnostic problem? Eur J Epidemiol. 1998;14:519–20. DOIPubMedGoogle Scholar
  5. Cutay  AM, Horowitz  HW, Pooley  RW, Van Horn  K, Wormser  GP. Infection of epicardial pacemaker wires due to Mycobacterium abscessus. Clin Infect Dis. 1998;26:520–1. DOIPubMedGoogle Scholar
  6. Verghese  S, Mullaseri  A, Padmaja  P, Subhadra  AC, Cherian  KM. Pacemaker implant site infection caused by atypical mycobacteria. Indian Heart J. 1998;50:201–2.PubMedGoogle Scholar
  7. Kessler  AT, Kourtis  AP. Mycobacterium abscessus as a cause of pacemaker infection. Med Sci Monit. 2004;10:CS60–2.PubMedGoogle Scholar
  8. Hemmersbach-Miller  M, Cardenes-Santana  MA, Conde-Martel  A, Bolanos-Guerra  JA, Campos-Herrero  MI. Cardiac device infections due to Mycobacterium fortuitum. Can J Infect Dis Med Microbiol. 2005;16:183–5.PubMedGoogle Scholar
  9. Sharma  S, Tleyjeh  IM, Espinosa  RE, Costello  BA, Baddour  LM. Pacemaker infection due to Mycobacterium fortuitum. Scand J Infect Dis. 2005;37:66–7. DOIPubMedGoogle Scholar
  10. Short  WR, Emery  C, Bhandary  M, O’Donnell  JA. Misidentification of Mycobacterium peregrinum, the causal organism of a case of bacteremia and automatic implantable cardioverter defibrillator-associated infection, due to its unusual acid-fast staining characteristics. J Clin Microbiol. 2005;43:2015–7. DOIPubMedGoogle Scholar
  11. Pastor  E, Luz Andreu  A, Llombart  M, Chiner  E. Mycobacterium fortuitum: a rare cause of pacemaker infection [in Spanish]. Enferm Infecc Microbiol Clin. 2006;24:136–7. DOIPubMedGoogle Scholar
  12. Toda  H, Sato  K, Iimori  M, Yamazumi  T, Furuta  I, Satoh  A, A case of Mycobacterium goodii infection with isolation from blood and a pacemaker lead [in Japanese]. Kansenshogaku Zasshi. 2006;80:262–6. DOIPubMedGoogle Scholar
  13. Giannella  M, Valerio  M, Franco  JA, Marin  M, Bouza  E, Munoz  P. Pacemaker infection due to Mycobacterium fortuitum: the role of universal 16S rRNA gene PCR and sequencing. Diagn Microbiol Infect Dis. 2007;57:337–9. DOIPubMedGoogle Scholar
  14. Simmon  KE, Pounder  JI, Greene  JN, Walsh  F, Anderson  CM, Cohen  S, Identification of an emerging pathogen, Mycobacterium massiliense, by rpoB sequencing of clinical isolates collected in the United States. J Clin Microbiol. 2007;45:1978–80. DOIPubMedGoogle Scholar
  15. Siu  CW, Cheng  LC, Woo  PC, Lau  CP, Tse  HF. A patient with relapsing pacemaker infection due to “Gram-positive bacilli”. Int J Cardiol. 2007;114:E40–1. DOIPubMedGoogle Scholar
  16. Tam  WO, Yew  WW, Yam  WC, Yuen  KY, Wong  PC, Tse  TF. Pacemaker infections due to rapidly growing mycobacteria: further experience. Int J Tuberc Lung Dis. 2007;11:118.PubMedGoogle Scholar
  17. Chrissoheris  MP, Kadakia  H, Marieb  M, Libertin  C. Pacemaker pocket infection due to Mycobacterium goodii: case report and review of the literature. Conn Med. 2008;72:75–7.PubMedGoogle Scholar
  18. Al Soub  H, Al Maslamani  M, Al Khuwaiter  J, El Deeb  Y, Abu Khattab  M. Myocardial abscess and bacteremia complicating Mycobacterium fortuitum pacemaker infection: case report and review of the literature. Pediatr Infect Dis J. 2009;28:1032–4. DOIPubMedGoogle Scholar
  19. Marchandin  H, Battistella  P, Calvet  B, Darbas  H, Frapier  JM, Jean-Pierre  H, Pacemaker surgical site infection caused by Mycobacterium goodii. J Med Microbiol. 2009;58:517–20. DOIPubMedGoogle Scholar
  20. van Duin  D, Goldfarb  J, Schmitt  SK, Tomford  JW, Tuohy  MJ, Hall  GS. Nontuberculous mycobacterial blood stream and cardiac infections in patients without HIV infection. Diagn Microbiol Infect Dis. 2010;67:286–90. DOIPubMedGoogle Scholar
  21. Karnam  S, Alla  VM, Kwon  J, Harbert  T, Sharma  A, Airey  K, Mycobacterium phlei, a previously unreported cause of pacemaker infection: thinking outside the box in cardiac device infections. Cardiol J. 2011;18:687–90. DOIPubMedGoogle Scholar
  22. Amraoui  S, Texier-Maugein  J, Bordachar  P. PET scan in suspected but unproven pacemaker endocarditis. Arch Cardiovasc Dis. 2012;105:125–6. DOIPubMedGoogle Scholar
  23. Sharma  H, Keshavan  A, Little  MA, Cross  J, Lipman  MC, Talukdar  S, Fortuitous vasculitis. Ren Fail. 2012;34:378–82. DOIPubMedGoogle Scholar
  24. Hooda  A, Pati  PK, John  B, George  PV, Michael  JS. Disseminated Mycobacterium chelonae infection causing pacemaker lead endocarditis in an immunocompetent host. BMJ Case Rep. 2014;2014:pii: bcr201406042.
  25. Li  J, Sexton  D, Mick  N, Nettles  R, Fowler  V, Ryan  T Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis. 2000;30:633–8. DOIPubMedGoogle Scholar
  26. Amin  M, Gross  J, Andrews  C, Furman  S. Pacemaker infection with Mycobacterium avium complex. Pacing and clinical electrophysiology. Pacing Clin Electrophysiol. 1991;14:152–4. DOIPubMedGoogle Scholar
  27. Katona  P, Wiener  I, Saxena  N. Mycobacterium avium–intracellulare infection of an automatic implantable cardioverter defibrillator. Am Heart J. 1992;124:1380–1. DOIPubMedGoogle Scholar
  28. Doherty  JG, Rankin  R, Kerr  F. Miliary tuberculosis presenting as infection of a pacemaker pulse-generator pocket. Scott Med J. 1996;41:20–1.PubMedGoogle Scholar
  29. Hellwig  T, Ou  P, Offredo  C, Stephany  D, Bonnet  D, Sidi  D. Unusual chronic pacemaker infection by Mycobacterium tuberculosis in a pediatric patient. J Thorac Cardiovasc Surg. 2005;130:937–8. DOIPubMedGoogle Scholar
  30. Kestler  M, Reves  R, Belknap  R. Pacemaker wire infection with Mycobacterium tuberculosis: a case report and literature review. Int J Tuberc Lung Dis. 2009;13:272–4.PubMedGoogle Scholar
  31. Luckie  M, Zaidi  A, Woodhead  M, Garratt  C. Mycobacterium tuberculosis causing infection of an implantable biventricular defibrillator. Indian J Tuberc. 2010;57:213–5.PubMedGoogle Scholar
  32. Stone  DR, Estes  NA III, Klempner  MS. Mycobacterium bovis infection of an implantable defibrillator following intravesical therapy with bacille Calmette-Guerin. Clin Infect Dis. 1993;16:825–6. DOIPubMedGoogle Scholar
  33. Kumar  A, Agrawal  T. A study of unusual pacemaker infection by mycobacterium tuberculosis in Indian patients. Indian Pacing Electrophysiol J. 2014;14:291–6.PubMedGoogle Scholar
  34. Wallace  RJ Jr, Musser  JM, Hull  SI, Silcox  VA, Steele  LC, Forrester  GD, Diversity and sources of rapidly growing mycobacteria associated with infections following cardiac surgery. J Infect Dis. 1989;159:708–16. DOIPubMedGoogle Scholar
  35. Wallace  RJ Jr, Steele  LC, Labidi  A, Silcox  VA. Heterogeneity among isolates of rapidly growing mycobacteria responsible for infections following augmentation mammaplasty despite case clustering in Texas and other southern coastal states. J Infect Dis. 1989;160:281–8. DOIPubMedGoogle Scholar
  36. Uslan  DZ, Kowalski  TJ, Wengenack  NL, Virk  A, Wilson  JW. Skin and soft tissue infections due to rapidly growing mycobacteria: comparison of clinical features, treatment, and susceptibility. Arch Dermatol. 2006;142:1287–92. DOIPubMedGoogle Scholar
  37. El Helou  G, Hachem  R, Viola  GM, El Zakhem  A, Chaftari  AM, Jiang  Y, Management of rapidly growing mycobacterial bacteremia in cancer patients. Clin Infect Dis. 2013;56:843–6. DOIPubMedGoogle Scholar
  38. Nash  KA, Zhang  Y, Brown-Elliott  BA, Wallace  RJ Jr. Molecular basis of intrinsic macrolide resistance in clinical isolates of Mycobacterium fortuitum. J Antimicrob Chemother. 2005;55:170–7. DOIPubMedGoogle Scholar
  39. Schembri  S, Williamson  PA, Short  PM, Singanayagam  A, Akram  A, Taylor  J, Cardiovascular events after clarithromycin use in lower respiratory tract infections: analysis of two prospective cohort studies. BMJ. 2013;346:f1235. DOIPubMedGoogle Scholar
  40. Lapi  F, Wilchesky  M, Kezouh  A, Benisty  JI, Ernst  P, Suissa  S. Fluoroquinolones and the risk of serious arrhythmia: a population-based study. Clin Infect Dis. 2012;55:1457–65. DOIPubMedGoogle Scholar

Main Article

Page created: February 16, 2016
Page updated: February 16, 2016
Page reviewed: February 16, 2016
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
file_external