CID 1992: 15 (December)
Correspondence
amoxicillin/clavulanate, azlocillin, ticarcillin, cefuroxime, cefotaxime, cefoxitin, ceftazidime, aztreonam, and trimethoprim, as determined by MICs. We contend that the epidemiological niche for O. anthropi is in CVC-related infections that may occur in any patient requiring such intervention and not exclusively in those who are immunocompromised. Isolation ofthe organism should raise suspicion of CVC-related infection. In our experience the infection can be successfully managed by removal of the infected catheter without resorting to antimicrobial therapy, a common practice with many CVC-associated infections.
SIR-We read with great interest the recent correspondence of Triesenberg et al. [I]. We describe an additional patient who developed group B streptococcal infection ofa prosthetic device (a pacemaker wire) following sigmoidoscopy. A 51-year-old nurse presented with chills, fever, and headache that developed abruptly the morning that she was admitted to the hospitaL She had undergone flexible sigmoidoscopic examination 2 days before the onset of chills and fever for rectal bleeding, which had been present for 5 days. No endoscopic biopsy had been performed and no prophylactic antibiotics had been administered. The patient had a history of allergy to penicillin and chronic liver disease caused by hepatitis C virus, and she had had a permanent pacemaker placed 20 days before admission. The patient was febrile on admission and had rigors. The pacemaker generator site on the chest wall appeared normal, and roentgenography of the chest revealed no abnormalities. She had a (previously described) grade 2/6 holosystolic murmur heard best at the cardiac apex. No diastolic murmurs were auscultated. No valvulopathies or vegetations were demonstrated on two-dimensional echocardiography. No peripheral skin lesions were found. Both sets of pretreatment blood cultures yielded group B streptococci. Despite receiving combined therapy with vancomycin and rifampin, the patient continued to manifest high fever, and the pacemaker was removed. The generator site showed no evidence of infection. Unfortunately, the pacemaker wire was not sent for microbiological examination. The patient's fever subsided rapidly following removal of the pacemaker generator and wire. After 14 days ofcombined antibiotic therapy, another pacemaker unit was implanted at a differ-
Correspondence: Dr. Larry M. Baddour, Department of Medicine. Suite 222 POB 1. University of Tennessee Medical Center at Knoxville. 1924 Alcoa Highway U-114. Knoxville. Tennessee 37920-6999. Clinical Infectious Diseases 1992;15:1069 © 1992by The University of Chicago. All rights reserved.
1058-4838/92/1506-0041$02.00
W. R. Gransden and Susannah J. Eykyn Division of Microbiology. United Medical and Dental Schools of Guy's and St Thomas's Hospitals. St Thomas's Campus. London. United Kingdom
References I. Cieslak TJ. Robb ML. Drabick CJ. Fischer GW.Catheter-related sepsis caused by Ochrobactrum anthropi: report of a case and review of related nonfermentative bacteria. Clin Infect Dis 1992; 14:902-7.
ent chest-wall site. She was discharged home and was followed as an outpatient. We believe that this patient's group B streptococcal infection was caused by the colonoscopic procedure, which resulted in transient bacteremia and secondary colonization of a recently inserted pacemaker wire. h is interesting that our patient was a nurse who worked in neonatal and pediatric intensive care units and occasionally cared for newborns with group B streptococcal disease. Thus it is possible that the source of our patient's group B streptococcal colonization was nosocomial [2]. Because of her underlying liver disease, she may have been less able to resolve the transient bacteremia caused by the endoscopic procedure and subsequently developed the pacemaker wire infection. Regardless, present recommendations of the American Heart Association do not support the routine use of prophylactic antibiotics for gastrointestinal endoscopic procedures, especially if the patient has a cardiac pacemaker [3]. A recent survey of cardiothoracic surgeons and cardiologists indicates that the majority (69%) follow these recommendations [4]. More intensive investigation of the use of antibiotic prophylaxis in patients undergoing lower gastrointestinal endoscopic examination will be required if additional case reports mirror our experience.
Larry M. Baddour and James W. Cox, Jr. Graduate School of Medicine. Department of Medicine. Divisions of Infectious Diseases and Cardiology. University of Tennessee Medical Center at Knoxville. Knoxville. Tennessee References I. Triesenberg SN. Clark NM. Kauffman CA. Group B streptococcal prosthetic joint infection following sigmoidoscopy. Clin Infect Dis 1992; 15:374-5. 2. Paredes A. Wong P. Mason EO Jr. et al. Nosocomial transmission of group B streptococci in a newborn nursery. Pediatrics 1976;59:67982. 3. Dajani AS. Bisno AI, Chung KJ. et al. Prevention of bacterial endocarditis. JAMA 1990;264:2919-22. 4. Vlay Sc. Prevention of bacterial endocarditis in patients with permanent pacemakers and automatic internal cardioverter defibrillators. Am HeartJ 1990;120:1490-2.
Downloaded from http://cid.oxfordjournals.org/ at New York University on May 6, 2015
Group B Streptococcal Infection of a Pacemaker Wire Following Sigmoidoscopy
1069
Correspondence
amoxicillin/clavulanate, azlocillin, ticarcillin, cefuroxime, cefotaxime, cefoxitin, ceftazidime, aztreonam, and trimethoprim, as determined by MICs. We contend that the epidemiological niche for O. anthropi is in CVC-related infections that may occur in any patient requiring such intervention and not exclusively in those who are immunocompromised. Isolation ofthe organism should raise suspicion of CVC-related infection. In our experience the infection can be successfully managed by removal of the infected catheter without resorting to antimicrobial therapy, a common practice with many CVC-associated infections.
SIR-We read with great interest the recent correspondence of Triesenberg et al. [I]. We describe an additional patient who developed group B streptococcal infection ofa prosthetic device (a pacemaker wire) following sigmoidoscopy. A 51-year-old nurse presented with chills, fever, and headache that developed abruptly the morning that she was admitted to the hospitaL She had undergone flexible sigmoidoscopic examination 2 days before the onset of chills and fever for rectal bleeding, which had been present for 5 days. No endoscopic biopsy had been performed and no prophylactic antibiotics had been administered. The patient had a history of allergy to penicillin and chronic liver disease caused by hepatitis C virus, and she had had a permanent pacemaker placed 20 days before admission. The patient was febrile on admission and had rigors. The pacemaker generator site on the chest wall appeared normal, and roentgenography of the chest revealed no abnormalities. She had a (previously described) grade 2/6 holosystolic murmur heard best at the cardiac apex. No diastolic murmurs were auscultated. No valvulopathies or vegetations were demonstrated on two-dimensional echocardiography. No peripheral skin lesions were found. Both sets of pretreatment blood cultures yielded group B streptococci. Despite receiving combined therapy with vancomycin and rifampin, the patient continued to manifest high fever, and the pacemaker was removed. The generator site showed no evidence of infection. Unfortunately, the pacemaker wire was not sent for microbiological examination. The patient's fever subsided rapidly following removal of the pacemaker generator and wire. After 14 days ofcombined antibiotic therapy, another pacemaker unit was implanted at a differ-
Correspondence: Dr. Larry M. Baddour, Department of Medicine. Suite 222 POB 1. University of Tennessee Medical Center at Knoxville. 1924 Alcoa Highway U-114. Knoxville. Tennessee 37920-6999. Clinical Infectious Diseases 1992;15:1069 © 1992by The University of Chicago. All rights reserved.
1058-4838/92/1506-0041$02.00
W. R. Gransden and Susannah J. Eykyn Division of Microbiology. United Medical and Dental Schools of Guy's and St Thomas's Hospitals. St Thomas's Campus. London. United Kingdom
References I. Cieslak TJ. Robb ML. Drabick CJ. Fischer GW.Catheter-related sepsis caused by Ochrobactrum anthropi: report of a case and review of related nonfermentative bacteria. Clin Infect Dis 1992; 14:902-7.
ent chest-wall site. She was discharged home and was followed as an outpatient. We believe that this patient's group B streptococcal infection was caused by the colonoscopic procedure, which resulted in transient bacteremia and secondary colonization of a recently inserted pacemaker wire. h is interesting that our patient was a nurse who worked in neonatal and pediatric intensive care units and occasionally cared for newborns with group B streptococcal disease. Thus it is possible that the source of our patient's group B streptococcal colonization was nosocomial [2]. Because of her underlying liver disease, she may have been less able to resolve the transient bacteremia caused by the endoscopic procedure and subsequently developed the pacemaker wire infection. Regardless, present recommendations of the American Heart Association do not support the routine use of prophylactic antibiotics for gastrointestinal endoscopic procedures, especially if the patient has a cardiac pacemaker [3]. A recent survey of cardiothoracic surgeons and cardiologists indicates that the majority (69%) follow these recommendations [4]. More intensive investigation of the use of antibiotic prophylaxis in patients undergoing lower gastrointestinal endoscopic examination will be required if additional case reports mirror our experience.
Larry M. Baddour and James W. Cox, Jr. Graduate School of Medicine. Department of Medicine. Divisions of Infectious Diseases and Cardiology. University of Tennessee Medical Center at Knoxville. Knoxville. Tennessee References I. Triesenberg SN. Clark NM. Kauffman CA. Group B streptococcal prosthetic joint infection following sigmoidoscopy. Clin Infect Dis 1992; 15:374-5. 2. Paredes A. Wong P. Mason EO Jr. et al. Nosocomial transmission of group B streptococci in a newborn nursery. Pediatrics 1976;59:67982. 3. Dajani AS. Bisno AI, Chung KJ. et al. Prevention of bacterial endocarditis. JAMA 1990;264:2919-22. 4. Vlay Sc. Prevention of bacterial endocarditis in patients with permanent pacemakers and automatic internal cardioverter defibrillators. Am HeartJ 1990;120:1490-2.
Downloaded from http://cid.oxfordjournals.org/ at New York University on May 6, 2015
Group B Streptococcal Infection of a Pacemaker Wire Following Sigmoidoscopy
1069
