Presence Of Implanted Devices Research Articles

Insight into Kytococcus schroeteri Infection Management: A Case Report and Review.

Background: Kytococcus schroeteri is a member of normal skin microflora, which can cause lethal infections in immunosuppressed hosts. In this review we attempted to draw patterns of its pathogenicity, which seem to vary regarding host immune status and the presence of implantable devices. Evidence suggests this pathogen houses many resistance-forming proteins, which serve to exacerbate the challenge in curing it. Available information on K. schroeteri antibacterial susceptibility is scarce. In this situation, a novel, genome-based antibiotic resistance analysis model, previously suggested by Su et al., could aid clinicians dealing with unknown infections. In this study we merged data from observed antibiotic resistance patterns with resistance data demonstrated by DNA sequences. Methods: We reviewed all available articles and reports on K. schroeteri, from peer-reviewed online databases (ClinicalKey, PMC, Scopus and WebOfScience). Information on patients was then subdivided into patient profiles and tabulated independently. We later performed K. schroeteri genome sequence analysis for resistance proteins to understand the trends K. schroeteri exhibits. Results: K. schroeteri is resistant to beta-lactams, macrolides and clindamycin. It is susceptible to aminoglycosides, tetracyclines and rifampicin. We combined data from the literature review and sequence analysis and found evidence for the existence of PBP, PBP-2A and efflux pumps as likely determinants of K. schroeteri. Conclusions: Reviewing the data permits the speculation that baseline immune status plays a role in the outcome of a Kytococcal infection. Nonetheless, our case report demonstrates that the outcome of a lower baseline immunity could still be favorable, possibly using rifampicin in first-line treatment of infection caused by K. schroeteri.

Abstract 19312: Multiplexed Images of the Heart Provide Novel Functional Information to Guide Invasive Procedures: A Review of the Initial Case Series

Introduction: The novel, high sensitivity and dedicated cardiac camera (D-SPECT, Spectrum Dynamics) allows single or dual tracer studies to add functional information to 3D DICOM image information from CT or CMR. Information consists of either perfusion information (from (technetium-99m (Tc-99m) methoxyisobutylisonitrile (MIBI, for perfusion) and/or sympathetic nnervation information using meta-iodobenzylguanidine (mIBG). Merging these 3D images with invasive 3D electroanatomical maps (EAM) offers image integration on a function rather than geometrical level alone. These fused 3D images can be combined with EAM to guide ablation procedures for either atrial or ventricular arrhythmias. Methods: A total of 23 patients (15 male, mean age 59.9 yrs) underwent either single iodine-123 mIBG (n=10, for sympathetic innervation) or dual tracer (n= 13, mIBG+MIBI, for perfusion) imaging and the acquired information was fused with the 3D cCT or CMR using a custom-made software. Results: Twenty out of 23 patients underwent invasive electrophysiology studies which targeted either atrial or ventricular arrhythmias. During the atrial arrhythmia procedures, high uptake sites for mIBG was correlated to positive effect of high frequency stimulation (=transient prolongation of AV nodal conduction) and thereby confirming ganglionated plexi which were targeted in addition to the standard ablation. Patients with ventricular arrhythmia, low amplitude voltage mapping showed good correlation to the perfusion scar imaging, thereby serving as a substrate map even in patients with implantable devices. Interestingly, regions of mismatch where identified which proved to be pro-arrhythmogenic during EP study in the 4/6 patients who underwent ventricular tachycardia (VT) ablation. Conclusion: The combination of innervation (by mIBG) and perfusion (by MIBI) nuclear imaging in addition to the 3D cCT or CMR imaging provides a novel type of “road map” information for complex arrhythmia ablation by providing a region of mismatch of innervation and perfusion. This provides a novel substrate information even in the presence of implantable devices.