Automatic implantable cardioverter defibrillator pocket infection due to Providencia rettgeri: A case report

Abstract

Coagulase-negative staphylococci and Staphylococcus aureus are the commonest pathogens involved in infections of pacemaker-defibrillator systems. Among causative Gram-negative bacteria, infections due to Klebsiella, Serratia, Pseudomonas, Acinetobacter and other species have been reported. We report herein a unique case of an automatic implantable cardioverter defibrillator infection due to Providencia rettgeri in a 65-year-old male who was admitted to our service with bacteremia and infection of the generator and subcutaneous array in a recently implanted device. Introduction: Insertion of an automatic implantable cardioverter-defibrillator (ICD) reduces the occurrence of sudden death in patients at risk for ventricular tachycardia or ventricular fibrillation [1]. Despite the advent of transvenously placed devices and improvements in surgical techniques, device infection is still a serious complication due to associated morbidity, mortality and financial costs [2]. Management of this clinical entity is challenging since no current guidelines are available for optimal treatment. We present a case of an ICD pocket infection due to an uncommon pathogen. Case presentation: This is a case of a 65-year-old Jewish male who presented to our hospital complaining of a two-week history of sero-sanguineous oozing coming from a healing surgical wound overlying an ICD that had been implanted sixteen days prior to the day of admission at a different medical center. No purulent discharge was seen. The area became increasingly painful. The patient denied any fevers, chills, palpitations or other cardiovascular symptoms on admission. Vital signs were as follows: Temperature of 98.4° F, Blood pressure of 105/64 mmHg, Heart rate of 60 beats per minute, Respiratory rate of 14 breaths per minute and Oxygen saturation of 98% on room air. Physical examination revealed an eight-centimeter irregularly oval, warm, swollen, erythematous and tender area on the left anterior-superior chest wall. No local ulcers or new heart murmurs were noticed. Poor dentition, together with the presence of disheveling appearance was appreciated. Past medical history was positive for non-ischemic dilated cardiomyopathy, congestive heart failure (NYHA class III), atrial fibrillation, essential hypertension and a recent syncopal episode. The patient had no history of alcohol, tobacco or illegal drug abuse. He was a retired messenger since 2004 and lived in a shelter. No family history of cardiomyopathy or oncologic diseases was noted. Admission laboratory findings revealed mild leukocytosis together with mild normocytic normochromic anemia (Table 1). An electrocardiogram showed atrial paced rhythm at 60 beats per minute, a QRS complex of 102 msec and a QTc interval of 480 sec, no signs of ischemia were recorded. His home medications included Warfarin, Carvedilol, Lisinopril and Simvastatin. © 2009 licensee BioMed Central Ltd.