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Abstract：
With the rising utilization of cardiovascular implantable electronic devices (CIEDs), infections secondary to device implantation are increasingly encountered. Staphylococcus aureus and coagulase-negative staphylococci are usually the predominant causative organisms. A CIED infection due to non-tuberculous mycobacteria (NTM) is extremely rare.
A 68-year-old man was admitted to our hospital with a history of pain and swelling at his cardiac resynchronization therapy-defibrillator (CRT-D) pocket site, for 4 days. The CRT-D had been implanted 2 weeks prior. The exudate smear was positive for acid-fast bacilli and culture results revealed rapidly growing nontuberculous mycobacteria (RGM). After an urgent removal of the device followed by 1 year of antibiotic treatment, the patient was completely cured. A new device was finally implanted, 3 years later.
Infections caused by nontuberculous mycobacteria following the implantation of cardiac devices are very rare. The typical manifestations of post-implantation CIED infections caused by RGMs include an early onset, with local redness, swelling, and spontaneous drainage. Systemic symptoms such as fever, chills, and fatigue are absent. Mycobacterium fortuitum is the most common species of RGM implicated in CIED infections, the manifestations of which usually appear within several weeks of the implantation procedure. An urgent removal of the device and appropriate antibiotic therapy are essential therapeutic measures. This is the first such reported case, in which the patient has been re-implanted with another device at the same site, after achieving a complete cure. We followed-up the patient for an additional 3 years and observed that the patient remained free of infection. Our case report shows that though an RGM infection is rare and difficult to treat, it can be completely cured. In addition, we demonstrated that it is subsequently possible to safely re-implant a CIED for the patient, at the same site.
A 68-year-old man was admitted to our hospital with a history of pain and swelling at his cardiac resynchronization therapy-defibrillator (CRT-D) pocket site, for 4 days. The CRT-D had been implanted 2 weeks prior. The exudate smear was positive for acid-fast bacilli and culture results revealed rapidly growing nontuberculous mycobacteria (RGM). After an urgent removal of the device followed by 1 year of antibiotic treatment, the patient was completely cured. A new device was finally implanted, 3 years later.
Infections caused by nontuberculous mycobacteria following the implantation of cardiac devices are very rare. The typical manifestations of post-implantation CIED infections caused by RGMs include an early onset, with local redness, swelling, and spontaneous drainage. Systemic symptoms such as fever, chills, and fatigue are absent. Mycobacterium fortuitum is the most common species of RGM implicated in CIED infections, the manifestations of which usually appear within several weeks of the implantation procedure. An urgent removal of the device and appropriate antibiotic therapy are essential therapeutic measures. This is the first such reported case, in which the patient has been re-implanted with another device at the same site, after achieving a complete cure. We followed-up the patient for an additional 3 years and observed that the patient remained free of infection. Our case report shows that though an RGM infection is rare and difficult to treat, it can be completely cured. In addition, we demonstrated that it is subsequently possible to safely re-implant a CIED for the patient, at the same site.
摘要：
随着心血管植入式电子设备(CIED)使用率的上升，继发于装置植入的感染越来越多。金黄色葡萄球菌和凝固酶阴性葡萄球菌通常是主要的致病生物。由非结核分枝杆菌（NTM）引起的ACIED感染极为罕见。
一名68岁男子因心脏再同步治疗-除颤器(CRT-D)口袋部位疼痛和肿胀病史入院，4天。2周前植入了CRT-D。渗出物涂片对耐酸杆菌呈阳性，培养结果显示非结核分枝杆菌（RGM）生长迅速。在紧急移除装置后，再进行1年的抗生素治疗，病人完全痊愈了。一个新装置终于被植入,三年后。
植入心脏装置后由非结核分枝杆菌引起的感染非常罕见。由RGM引起的植入后CIED感染的典型表现包括早期发作，局部发红，肿胀,和自发排水。全身症状，如发烧，发冷,疲劳是不存在的。偶发分枝杆菌是与CIED感染有关的最常见的RGM物种，其表现通常在植入手术后几周内出现。紧急移除装置和适当的抗生素治疗是必要的治疗措施。这是首例此类病例,患者在同一部位重新植入了另一个装置，在实现完全治愈之后。我们对患者进行了额外的3年随访，观察到患者没有感染。我们的病例报告显示，尽管RGM感染罕见且难以治疗，它可以完全治愈。此外,我们证明了随后可以安全地为患者重新植入aCIED，在同一地点。
一名68岁男子因心脏再同步治疗-除颤器(CRT-D)口袋部位疼痛和肿胀病史入院，4天。2周前植入了CRT-D。渗出物涂片对耐酸杆菌呈阳性，培养结果显示非结核分枝杆菌（RGM）生长迅速。在紧急移除装置后，再进行1年的抗生素治疗，病人完全痊愈了。一个新装置终于被植入,三年后。
植入心脏装置后由非结核分枝杆菌引起的感染非常罕见。由RGM引起的植入后CIED感染的典型表现包括早期发作，局部发红，肿胀,和自发排水。全身症状，如发烧，发冷,疲劳是不存在的。偶发分枝杆菌是与CIED感染有关的最常见的RGM物种，其表现通常在植入手术后几周内出现。紧急移除装置和适当的抗生素治疗是必要的治疗措施。这是首例此类病例,患者在同一部位重新植入了另一个装置，在实现完全治愈之后。我们对患者进行了额外的3年随访，观察到患者没有感染。我们的病例报告显示，尽管RGM感染罕见且难以治疗，它可以完全治愈。此外,我们证明了随后可以安全地为患者重新植入aCIED，在同一地点。
