title: Contamination of transvenous pacemaker leads due to tunneled hemodialysis catheter infection: a report of 2 cases.
abstract: Catheter-related bacteremia is a frequent complication associated with the use of tunneled hemodialysis catheters. Catheter-related bacteremia can lead to metastasis of infection to other sites. This article presents 2 patients with transvenous pacemakers (placed >2 years ago) who were receiving long-term hemodialysis therapy using tunneled hemodialysis catheters. Both were admitted to the hospital with catheter-related bacteremia. Blood cultures showed methicillin-resistant Staphylococcus aureus (MRSA) in both cases. Transesophageal echocardiography was negative for the presence of valvular endocarditis, but showed lead-associated vegetation in both cases. Intravenous antibiotic therapy was initiated, and both the tunneled hemodialysis catheters and cardiac devices were removed by a cardiothoracic surgeon. The catheter tip and leads cultures showed MRSA in both cases. After resolution of bacteremia, both patients received an epicardial cardiac device. Antibiotic therapy was continued for 6 weeks. Renal physicians providing dialysis therapy should be aware that catheter-related bacteremia could cause contamination of transvenous pacemaker leads. Because catheter-related bacteremia is a frequent complication, epicardial leads might be considered as an alternative route to provide cardiac support to catheter-consigned patients. Epicardial leads do not navigate through the central veins, lie in the path of blood flow, or cause central venous stenosis.
authors.affiliation: Division of Cardiothoracic Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
authors.forename: Roger G
authors.initials: RG
authors.lastname: Carrillo
authors.forename: Juan D
authors.initials: JD
authors.lastname: Garisto
authors.forename: Loay
authors.initials: L
authors.lastname: Salman
authors.forename: Donna
authors.initials: D
authors.lastname: Merrill
authors.forename: Arif
authors.initials: A
authors.lastname: Asif
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology*; D002408:Catheters, Indwelling / Q000382:microbiology*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000628:therapy*; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D010138:Pacemaker, Artificial / Q000382:microbiology*; D006435:Renal Dialysis / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology
chemical_list: D000900:Anti-Bacterial Agents