Research Day

Infection of Atrial Septal Defect Closure Device: Even Low Turbulence Devices Get Infected

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Introduction: Most intravascular infections are associated with situations with high turbulence. Therefore, situations with only low turbulence such as atrial septal defects both before and after repair, pure mitral stenosis and inferior vena cava filters rarely are associated with infection. We present a case of methicillin-resistant Staphylococcus aureus (MRSA) infection of a atrial septal defect occluder device (ASDO)in a intravenous drug user (IVDU). Case Report: A 38 year old IVDU was admitted with 2 days of fatigue and the abrupt onset of seizure-like activity and loss of consciousness. He was found to have a temperature of 41 C with peripheral leukocytosis and after blood cultures were obtained, he was begun on broad spectrum antimicrobials including vancomycin. Multiple blood cultures grew MRSA and a head MRI revealed multiple intracerebral emboli and hydrocephalus and an external ventricular drain was placed. Over several days, multiple blood cultures continue to grew MRSA and a TEE revealed large, multi-lobulated, mobile masses on both sides of the ASDO. Antimicrobials were switched to daptomycin, ceftaroline and rifampin. Cardiothoracic surgery intervention was initially deferred due to the instability of the patient. After modification of the antimicrobial therapy, blood culture became negative and the device was explanted 3 weeks later. Operative cultures were all no growth. After 7 weeks of antimicrobial therapy with 4 weeks of the course given postoperatively and continued negative blood cultures, the patient was transferred to a skilled nursing facility for further rehabilitation. A literature review resulted in a paucity of infections of ASDO devices. Conclusion: Infection of an ASDO is rare which is likely related to the low blood flow turbulence existing in the area of the device. This rarity underscores the risk of intravascular infections in this and other low turbulence intravascular scenarios. Despite this, clinicians should continue to recognize that these infections may occur.

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