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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

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Page updated: February 16, 2016
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