: Rare case of automatic implantable cardioverter-defibrillator (AICD) lead infection

Abstract

We present a rare case of Gemella haemolysans automated implantable cardioverter defibrillator (AICD) lead infection. Gemella species are catalase-negative, facultative anaerobic, Gram-positive cocci which are found in normal human oral flora. Gemella are often incorrectly identified on routine Gram stain and culture, requiring advanced techniques such as PCR. Gemella has been shown to be a rare cause infective endocarditis in case reports; however, there has not been a report of an isolated AICD lead infection. AICD infections with gram positive organisms other than Staphylococcus species has been associated with more aggressive infections and higher mortality. Standard treatment for Gemella consists of β-lactam inhibitors and aminoglycosides. In this case, we present an alternative antibiotic treatment with vancomycin and ceftriaxone. A case series for Gemella haemolysans endocarditis, without lead infection, reported the use of vancomycin and ceftriaxone with good results. This approach is similar to methicillin-resistant staphylococcus aureus (MRSA) bacteremia salvage therapy. In addition, this case highlights the importance of culture and sensitivity in the selection of antibiotics, particularly avoiding nephrotoxic drugs when possible.