Pacemaker Lead Endocarditis Caused by Achromobacter xylosoxidans

Abstract

We report the case of a 35-yr-old patient who presented with high fever and chills. He had undergone a patch closure of the ventricular septal defect 18 yr before. One year later, a VVI pacemaker was implanted via the right subclavian vein because of complete heart block. Nine years after that, a new VVI pacemaker with another right ventricular electrode was inserted controlaterally and the old pacing lead was abandoned. Trans-thoracic and trans-esophageal echocardiogram identified the pacemaker lead in the right ventricle (RV) attaching hyperechoic materials and also a fluttering round hyperechoic mass with a stalk in the RV outflow tract. Cultures in blood and pus from pacemaker lead grew Achromobacter xylosoxidans. A diagnosis of pacemaker lead endocarditis due to Achromobacter xylosoxidans was made. In this regards, the best treatment is an immediate removal of the entire pacing system and antimicrobial therapy.

Achromobacter species endocarditis: A Case Report and Literature Review

“…One patient was an intravenous drug user (9). Eight of the 13 patients (62%), including our patient, had prosthetic valves or underwent septal patch repairs (8)(9)(10)(14)(15)(16)(17). In patients without immunodeficiencies or chronic illnesses, these mechanical disruptions in the host defense system could be an important risk factor for Achromobacter endocarditis.…”

Achromobacter xylosoxidans Infection Presenting as a Pulmonary Nodule Mimicking Cancer

“…It is also a prevalent nosocomial colonizer and has been isolated from multiple types of aqueous solutions found in the health care setting, such as nonbacteriostatic saline (24), dialysis solutions (33), contact lens solutions (15), intravenous CT contrast solutions (32), chlorhexidine gluconate solutions (35), and ultrasound gel (28). A. xylosoxidans also colonizes fomites such as mechanical ventilators (6), neonatal incubators (25,29), faucet aerators (17,43), intravenous catheters (1,17,20,24), epidural catheters (30), urinary catheters (29), intravascular pressure transducers (17), pacemaker leads (2,26,33,36), and extracorporeal membrane oxygenation machines (21).…”

Native valve infective endocarditis due to Achromobacter xylosoxidans in an apparently immunocompetent individual

“…There are four case reports in the literature of prosthetic valve endocarditis secondary to A xylosoxidans 3 6 7 8 Martino et al in 1990 described one case of A xylosoxdians related native valve endocarditis in a patient undergoing bone marrow transplantation with an indwelling central venous catheter 9…”