关键词： drugs: infectious diseases medical management pacing and electrophysiology

Mesh ： Amikacin / therapeutic use Anti-Bacterial Agents / therapeutic use Anti-Infective Agents / therapeutic use Arrhythmias, Cardiac / complications Cefoxitin / therapeutic use Clarithromycin / therapeutic use Clofazimine / therapeutic use Drug Resistance, Bacterial Epidural Abscess / complications Heroin Dependence Humans Male Microbial Sensitivity Tests Middle Aged Mycobacterium Infections, Nontuberculous / drug therapy Mycobacterium abscessus Osteomyelitis / complications Pacemaker, Artificial Prosthesis-Related Infections / diagnosis

来  源：   DOI：10.1136/bcr-2019-230100   PDF(Sci-hub)   PDF(Pubmed)

Abstract：
Though prevalent in the environment, nontuberculous mycobacteria (NTM) have been increasingly identified as pathogenic. Sporadic reports of NTM infection of cardiac implantable electronic devices (CIEDs) have appeared but remain rare. This case describes a CIED infection with Mycobacterium abscessus, the third reported case in the literature. A 63-year-old male presented with a 3-day history of drainage from his pacemaker extraction site. An aspirate grew Mycobacterium abscessus Together with National Jewish Health, a treatment plan was developed, consisting of an induction phase with amikacin, cefoxitin and clarithromycin followed by a maintenance phase with clarithromycin and clofazimine. The clinical course was complicated by cardiac arrhythmia, abscess formation and thoracic osteomyelitis with epidural abscess. This case highlights a rare manifestation of Mycobacterium abscessus disease and suggests the need for further study. Treatment is complicated by unpredictable resistance patterns, complex antimicrobial regimens and the use of arrhythmogenic medications in patients with removed CIEDs.
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