Abstract 16276: Complex Corynebacterium Case: Management of Recurrent Corynebacterium Bacteremia in a Patient With Cardiac Implanted Electronic Device and Left Ventricular Assist Device

Abstract

Background Cardiac implantable electronic device (CIED) infections are morbid and costly. Atypical organisms are increasingly recognized as a cause of CIED infections. We present a case of recurrent Corynebacterium striatum bacteremia requiring CIED and left ventricular assist device (LVAD) extraction. Case Presentation A 54-year-old female dialysis patient with diabetes, ischemic cardiomyopathy, primary prevention single chamber transvenous defibrillator (ICD) 8 years prior, and destination LVAD presented with chronic C. striatum driveline site infection and relapsing and remitting bacteremia. Over the prior two years, she suffered from chronic driveline infections requiring wound care, driveline washouts, and antibiotics, although not seen by the electrophysiology (EP) team. After a fourth episode of bacteremia, she underwent ICD extraction and LVAD pump exchange, followed by 6 weeks of vancomycin and 3 months of rifampin. She then remained free of bacteremia for 19 months, though continued to demonstrate evidence of driveline infection despite pump exchange. Ultimately, C. striatum bacteremia recurred. Given unrelenting soft tissue infection and recurrent bacteremia, redo LVAD exchange was deferred and she was treated with lifelong suppressive antibiotics. Discussion Corynebacterium species have historically been considered skin flora, but more recently have been identified as pathogens, both as a cause of endocarditis, and a common organism in LVAD associated soft tissue infections. There are few reports of CIED infection. Source control is difficult in bacteremia patients with both CIED and LVAD. In this case, recurrent bacteremia could be attributed to recurrent driveline-soft tissue infection. However, the prolonged freedom from bacteremia off antibiotics after CIED extraction, despite ongoing soft tissue and driveline infection, argues that her transvenous ICD may have been seeded. This case highlights the growing spectrum of bacteria implicated in CIED-related infection, that early extraction may be a critical intervention regardless of infectious source, and importance of multidisciplinary discussions including heart failure, surgery, infectious disease, and EP to improve outcomes in this complex population.