Abstract
In pacemaker-related infections,as for all foreign body related infections,it is usually desirable to remove the infected device.However,we report the case of a patient undergoing treatment with a Cardiac Resynchronization TherapyDefibrillator (CRT-D) for severe arrhythmia in whom removal of the defibrillator was difficult and infection control was achieved only with antimicrobial chemotherapy.
The patient,in whom a CRT-D had been implanted for ventricular tachycardia,was hospitalized for catheter infection disease.She was diagnosed with infective endocarditis as methicillin-resistant Staphylococcus aureus (MRSA) was detected in a blood culture,and vegetation on the CRT-D lead by TTE.Owing to her severe arrhythmia,the lead was not removed,and a doctor requested a pharmacist’s advice on drug selection for antimicrobial chemotherapy and planning its administration.
We conducted administration planning for vancomycin,gentamycin,linezolid and arbekacin,achieved success in controlling vancomycin-intermediate resistant Staphylococcus aureus,and the vegetation disappeared.However,we encountered drug interactions and the adverse effects of hematologic abnormalities and renal dysfunction.
It has been suggested that treatment of infections associated with cardiac devices is possible using only antimicrobial chemotherapy if appropriate,effective antimicrobials are selected.However,it is generally necessary to continue such therapy for a long period of time in a patient like this and it is therefore important to be aware of the incidence of antimicrobial resistance,the adverse effects of antimicrobial agents,and drug interactions when selecting antimicrobials for treatment.
