A cardiac implantable device infection by Raoultella planticola in an immunocompromized patient.

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. Staphylococci are 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 as R. 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. planticola is 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.

[Interventional cardiology]. / Cardiologie interventionnelle.

Interventional cardiology has dramatically developed since its introduction in 1977. Angioplasty represents the first choice for coronary reperfusion during acute myocardial infarction with thromboaspiration and stenting of the culprit lesion. In acute coronary syndroms and stable angina or silent ischemia despite optimal medical treatment, angioplasty is today an excellent option for coronary revascularization which includes a technologic offer adapted to various clinical and anatomical situations (specific guidewires, rotative atherectomy, distal protection devices and drug eluting stents that reduce the risk of coronary reintervention after initial angioplasty). For patient with severe ischemic left ventricular dysfunction, interventional rythmology can improve patient prognosis by a limitation of lethal ventricular fibrillation. Despite the hope that intracoronary cell transplantation could save myocardial cells, several randomized control trials have given various and disappointing results concerning the potential improvement of left ventricular function. Interventional cardiology nowadays offers global technical solutions for more and more patients suffering from ischemic cardiomyopathy.