Simultaneous infection of abandoned leads and newly implanted leadless cardiac pacemaker: Why did this occur?

Abstract

With the incidence of cardiac implantable electric device (CIED) infection rising, leadless pacemakers are becoming increasingly popular in high-risk patients due to no lead-associated complications. However, few reports exist on leadless pacemaker infection and extraction. We herein describe a case of simultaneous pacemaker and leadless pacemaker extraction due to persistent bacteremia. Case report An 80-year-old man with a background history of dilated hypertrophic cardiomyopathy, hypertension, and chronic heart failure received a dual-chamber pacemaker for sick sinus syndrome and atrioventricular block in February 2010. On May 30, 2019, he developed pocket erosion, with streaks of pus exuding from the pocket (Fig. 1). He was readmitted on June 5, 2019 due to worsening symptoms. There was no evidence of blood stream infection, as indicated by negative blood and pus cultures and normal C-reactive protein (CRP) levels. The pacemaker generator was removed, although both capping leads were left buried under

Leadless Pacemaker Infection Risk in Patients with Cardiac Implantable Electronic Device Infections: A Case Series and Literature Review

“…Additionally, 11 (55%) patients had positive lead cultures. Antimicrobial therapy was administered for a median time of 27 [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] days after LP placement. The most common administered antimicrobial was daptomycin in 60% of cases.…”

“…None of these patients required LP extraction, and all were cured with antimicrobial therapy alone. Currently, only two documented cases of LP infection have been reported, to the best of our knowledge [16,17].…”

Antibacterial Designs for Implantable Medical Devices: Evolutions and Challenges

“…Antibiotic resistance in bacteria even multidrug-resistant (MDR) bacteria is now a worldwide challenge [ 91 ]. Antibiotic-resistant infections were frequently reported all over the world, including in both developing and developed countries ( Table 4 ) [ 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 ]. During an infection, Staphylococcus aureus ( S. aureus ) often forms biofilms on implantable devices, which dramatically increases the ability of the species to acquire resistance via horizontal plasmid transfer [ 111 ].…”

“…This is why S. aureus has high rates of resistance. As shown by the typical cases reported in recent years ( Table 4 ), MRSA has become the most common strain causing infections of various implantable medical devices, including cardiac devices [ 93 , 95 , 99 , 103 , 106 ], orthopedic prosthetics [ 96 , 97 ], cochlear implants [ 98 ], breast implants [ 100 ], laryngeal implants [ 101 ], and stent grafts [ 109 ]. In addition, there is an alarming increase in antibiotic resistance in other strains, such as Acinetobacter baumannii [ 92 ], Mycobacterium chelonae [ 94 ], Enterobacter cloacae complex [ 102 ], S. epidermidis [ 104 , 110 ], Klebsiella pneumoniae [ 105 ], Staphylococcus haemolyticus [ 107 ], and Staphylococcal endophthalmitis [ 108 ], are also involved in various resistant DAIs.…”

“…As shown by Table 3 and Table 4 , the latent period of a DAI can be days after implant placement [ 92 , 94 , 105 , 108 , 109 , 110 ], years after the surgery [ 78 , 79 , 93 , 95 ], or even decades later [ 67 , 68 ]. This feature of DAIs lays the basis for the development of antibacterial surfaces with long active durations.…”