Sotello Aviles, David A

Infection is a clinically relevant complication associated with intracardiac devices. Atypical mycobacteria, particularly Mycobacterium fortuitum, have been increasingly implicated in cardiovascular implantable electronic device (CIED) infections. We present a case of M. fortuitum CIED infection in a patient with ischaemic cardiomyopathy occurring approximately 3 weeks after insertion. The recognition and adequate treatment, including device removal, tissue sampling and the determination of antimicrobial sensitivities, are essential in the proper management of these patients.

We present a 49-year-old female with one year of intermittent fevers, chills, night sweats, and significant weight loss. Liver and lung biopsy showed evidence of a granulomatous process. Blood and liver biopsy cultures yielded growth of presumedMycobacterium interjectum, thought to be related to a disseminated long-term central venous catheter infection. She successfully received one year of combined antimicrobial therapy after catheter removal without recurrence of disease.M. interjectumhas been previously described as a cause of lymphadenitis in healthy children and associated with pulmonary disease in adults, although other localized infections have been reported. This is the first case described of a disseminatedM. interjectuminfection with bacteremia, hepatic and pulmonary involvement associated with a long-term catheter infection.

Abstract An elderly woman underwent an uncomplicated right hip replacement (total hip arthroplasty) in 2005 and returned 5 years later with cellulitis of the right hip. Treatment with oral antibiotics was initiated. Septic arthritis of the right hip joint was diagnosed ultimately, and she had surgical removal (explant) of the right hip prosthesis in 2011. Recurrent right hip infections ensued on several occasions with multiple antibiotic courses over the next 4 years. Although she had intermittent infections with methicillin-susceptible Staphylococcus aureus and methicillin-resistant Staphylococcus aureus, she had consistent and persistent isolation of Clostridium cadaveris from the hip beginning in 2013. After prolonged surgical interventions and several courses of antibiotics, C. cadaveris was eradicated; she has undergone implantation for a second stage implant (total hip arthroplasty) of the affected hip and remains stable to date.