Recurrent Endocarditis in a Patient with a Permanent Transvenous Pacemaker

Abstract

Description BK, an 80-year-old man with a pacemaker and a recent history of endocarditis caused by Staphylococcus epidermidis, was admitted with complaints of syncope and fever. Five years prior to this admission he was hospitalized for Stokes-Adams attacks. At that time, electrocardiogram revealed right bundle branch block and left anterior hemiblock; the PR interval was 0.18 seconds. While hospitalized for evaluation, he had an episode of syncope and cardiac arrest, shown to be complete atrioventricular block. A temporary pacer was inserted, followed under antibiotic coverage four days later by insertion of a Coratomic Model L500 permanent pacemaker. Postoperatively, the patient developed fever and phlebitis at the site of the temporary pacing wire. The electrode was removed, and oxacillin was given for a total of six days. The patient was discharged three days after discontinuation of that therapy.One year prior to this admission, a manufacturer's recall necessitated elective replacement of BK's pulse generator. A CPI Model 505 was implanted and connected to the old electrodes. The patient experienced no postoperative complications. Four months prior to this admission, the new pacemaker failed, demonstrating complete loss of capture. The pacer's output was therefore increased.One month later, BK was admitted with fever, chills, and syncopal episodes of ten days duration. Six blood cultures were positive for Staphylo-

Enterococcal Endocarditis and Penicillin Allergy

“…major toxic reaction to penicillin has already occurred. As described in a previous CDC [49], we model this control structure with a Boolean (or switch) node, denoted by the open triangle. If the logical variable :MPTOX is true (i.e., if a Major Penicillin TOXc reaction has occurred), then vancomycin is continued.…”