title: A cardiac implantable device infection byRaoultella planticolain an immunocompromized patient.
abstract: Introduction.Infection of cardiac implantable electronic devices is a severe condition associated with high mortality, particularly in patients who are dependent upon heart-pacing devices.Staphylococciare found in 70 % of reported cases.Case presentation.We report the case of a cardiac-pacemaker infection in a 79-year-old man, cumulating a history of rheumatoid arthritis treated by corticosteroids and methotrexate by a recently identified micro-organism:Raoultella planticola. He presented local signs of infection on his VVI pacemaker implantation site and underwent urgent pocket device replacement under cefamandole antibioprophylaxis. On incision thick pus oozed out. It was necessary to perform a complete hardware extraction comprising the pulse generator and the ancient lead. Pus was inoculated into aerobic and anaerobic culture vials and Gram staining unveiled Gram-negative rods. Microbiology analysis identified the organism asR. planticola.A new pacing device was inserted on the contrlateral pectoral region. Ciprofloxacin enabled full recovery. A literature review concerning this pathogen revealed that it is involved in severe infections such as bloodstream infections, peritonitis, cellulitis, pneumonia and lung abscesses, and urinary tract infections. In these case reports, underlying co-morbidities were identified such as solid active neoplasia, recent chemotherapy, corticosteroids, solid-organ-recipient patients and recent open surgery.Conclusion.R. planticolais a serious emerging pathogen and contributes to the burden of various infectious conditions. Its pathogenicity and occurrence should be known by clinicians and a high level of awareness is necessary to precisely identify it provide the correct antibiotic regimen.
authors.affiliation: Infectious and Tropical Diseases Department, Amiens University Hospital , Amiens , France.
authors.forename: Chandra
authors.initials: C
authors.lastname: Adjodah
authors.affiliation: Department of Cardiovascular Diseases, Basque Coast Hospital Centre , Bayonne , France.
authors.forename: Chistophe
authors.initials: C
authors.lastname: D'Ivernois
authors.affiliation: Department of Microbiology, Basque Coast Hospital Centre , Bayonne , France.
authors.forename: David
authors.initials: D
authors.lastname: Leyssene
authors.affiliation: Department of Cardiovascular Diseases, Basque Coast Hospital Centre , Bayonne , France.
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Berneau
authors.affiliation: Department of Cardiovascular Diseases, Basque Coast Hospital Centre , Bayonne , France.
authors.forename: Yann
authors.initials: Y
authors.lastname: Hemery
keywords: Raoultella planticola; corticosteroids; immunosuppression; implantable cardiac device infection; methotrexate; rheumatoid arthritis