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Micafungin for Candida Albicans Pacemaker-Associated Endocarditis: A Case Report and Review of the Literature

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Abstract

We report on the treatment with micafungin of a pacemaker-associated endocarditis due to Candida albicans. Antifungal therapy was able to reduce vegetation size from 5 to 1 cm making possible the transvenous removal of the device without a high risk of pulmonary embolism. Noteworthy, a high micafungin concentration was documented into the lead vegetation (10 μg/g of vegetation tissue) and this may have contributed to the striking size reduction of vegetation.

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References

  1. Eggiman P, Waldvogel F. Pacemaker and defibrillator infection. In: Waldvogel F, Bisno A, editors. Infections associated with indwelling medical devices. Washington: ASM press; 2000. p. 247–64.

    Google Scholar 

  2. Mond HG, Proclemer A. The 11th World Survey of Cardiac Pacing and Implantable Cardioverter-Defibrillators: calendar Year 2009—A World Society of Arrhythmia’s Project. Pacing Clin Electrophysiol. 2011;34(8):1013–27.

    Article  PubMed  Google Scholar 

  3. Bluhm G. Pacemaker infections. 2-year follow-up of antibiotic prophylaxis. Scand J Thorac Cardiovasc Surg. 1985;16:65–70.

    Article  Google Scholar 

  4. Lay KK, Fontecchio SA. Infections associated with implantable cardioverter defibrillators placed trasvenously and via thoracotomies: epidemiology, infection control, and management. Clin Infect Dis. 1998;27:265–9.

    Article  Google Scholar 

  5. Kearney RA, Eisen HJ, Wolf JE. Nonvalvular infections of the cardiovascular system. Ann Intern Med. 1994;121:219–30.

    PubMed  CAS  Google Scholar 

  6. Karchmer AW. Infections of prosthetic valves and intravascular devices. In: Mandell GL, Bennett JE, Dolin R, editors. Principles and practice of infectious diseases. Philadelphia: Churchill Livingstone; 2000. p. 911–3.

    Google Scholar 

  7. Arber N, Pras E, Copperman Y, Schapiro JM, Meiner V, Lossos IS, et al. Pacemaker endocarditis: report of 44 cases and review of the literature. Medicine (Baltimore). 1994;73:299–305.

    CAS  Google Scholar 

  8. Tascini C, Bongiorni MG, Gemignani G, Soldati E, Leonildi A, Arena G, et al. Management of cardiac device infections: a retrospective survey of a non-surgical approach combining antibiotic therapy with transvenous removal. J Chemot. 2006;18(2):157–63.

    CAS  Google Scholar 

  9. Baddour LM, Epstein AE, Erickson CC, Knight BP, Levison ME, Lockhart PB, et al. Update on cardiovascular implantable electronic device infections and their management: a scientific statement from the American Heart Association. Circulation. 2010;121(3):458–77.

    Article  PubMed  Google Scholar 

  10. Camus C, Leport C, Raffi F, Michelet C, Carteier F, Vilde JL. Sustained bacteraemia in 26 patients with a permanent endocardial pacemaker: assessment of wire removal. Clin Infect Dis. 1993;17:46–55.

    Article  PubMed  CAS  Google Scholar 

  11. Choo MH, Holmes DR Jr, Gersh JB, Maloney JD, Merideth J, Pluth JR, Trusty J. Permanent pacemaker infections: characterization and management. Am J Cardiol. 1981;48:559–64.

    Article  PubMed  CAS  Google Scholar 

  12. Rettig G, Doenecke P, Sen S, Volomer I, Bette L. Complications with retained transvenous pacemaker electrodes. Am Heart J. 1979;98:587–94.

    Article  PubMed  CAS  Google Scholar 

  13. Vogt PR, Sagdic K, Lachat M, Candinas R, von Segesser LK, Turina MI. Surgical management of infected permanent transvenous pacemaker system: ten years experience. J Card Surg. 1996;11:180–6.

    Article  PubMed  CAS  Google Scholar 

  14. Byrd CL, Schwartz SJ, Hedin NB, Goode LB, Fearnot NE, Smith HJ. Intravascular lead extraction using locking stylets and sheaths. Pacing Clin Electrophysiol. 1990;13:1871–5.

    Article  PubMed  CAS  Google Scholar 

  15. Manolis AS, Maounis TN, Chiladakis J, Vassilikov V, Melita-Manolis H, Cokkinos DV. Successful percutaneous extraction of pacemakers leads with a novel (vascoextor) pacing lead removal system. Am J Cardiol. 1998;81:935–8.

    Article  PubMed  CAS  Google Scholar 

  16. Wilhelm MJ, Schmid C, Hammel D, Kerber S, Loick HM, Hermann M, Scheld HH. Cardiac pacemaker infection; surgical management with or without extracorporeal circulation. Ann Thorac Surg. 1997;64:1707–12.

    Article  PubMed  CAS  Google Scholar 

  17. Smith MC, Love CJ. Extraction of trans-venous pacing and ICD leads. Pacing Clin Electrophysiol. 2008;31:736–52.

    Article  PubMed  Google Scholar 

  18. Baddour LM, Cha YM, Wilson WR. Clinical practice. Infections of cardiovascular implantable electronic devices. N Engl J Med. 2012;367(9):842–9.

    Article  PubMed  CAS  Google Scholar 

  19. Bongiorni MG, Tascini C, Tagliaferri E, Di Cori A, Soldati E, Leonildi A, Zucchelli G, Ciullo I, Menichetti F. Microbiology of cardiac implantable electronic device infections. Europace. 2012;14(9):1334–9.

    Google Scholar 

  20. Sohail MR, Uslan DZ, Khan AH, Friedman PA, Hayes DL, Wilson WR, Steckelberg JM, Stoner S, Baddour LM. Management and outcome of permanent and implantable cardioverter-defibrillator infections. J Am Coll Cardiol. 2007;49:1851–9.

    Article  PubMed  Google Scholar 

  21. Halawa A, Henry PD, Sarubbi FA. Candida endocarditis associated with cardiac rhythm management devices: review with current treatment guidelines. Mycoses. 2011;54(4):e168–74.

    Article  PubMed  Google Scholar 

  22. Pappas PG, Kauffman CA, Andes D, Benjamin DK Jr, Calandra TF, Edwards JE Jr, Filler SG, Fisher JF, Kullberg BJ, Ostrosky-Zeichner L, Reboli AC, Rex JH, Walsh TJ, Sobel JD. Infectious Diseases Society of America. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;48(5):503–35.

    Article  PubMed  CAS  Google Scholar 

  23. Talarmin JP, Boutoille D, Tattevin P, Abgueguen P, Ansart S, Roblot F, Raffi F. Candida endocarditis: role of new antifungal agents. Mycoses. 2009;52(1):60–6. Epub 2008 May 21.

    Article  PubMed  CAS  Google Scholar 

  24. Falcone M, Barzaghi N, Carosi G, Grossi P, Minoli L, Ravasio V, Rizzi M, Suter F, Utili R, Viscoli C, Venditti M. Italian Study on Endocarditis. Candida infective endocarditis: report of 15 cases from a prospective multicenter study. Medicine (Baltimore). 2009;88(3):160–8.

    Article  Google Scholar 

  25. d’Enfert C. Biofilms and their role in the resistance of pathogenic Candida to antifungal agents. Curr Drug Targets. 2006;7:465–70.

    Article  PubMed  Google Scholar 

  26. Mukherjee PK, Chandra J. Candida biofilm resistance. Drug Resist Updat. 2004;7:301–9.

    Article  PubMed  CAS  Google Scholar 

  27. Bachmann SP, VandeWalle K, Ramage G, Patterson TF, Wickes BL, Graybill JR, López-Ribot JL. In vitro activity of caspofungin against Candida albicans biofilms. Antimicrob Agents Chemother. 2002;46:3591–6.

    Article  PubMed  CAS  Google Scholar 

  28. Cateau E, Rodier MH, Imbert C. In vitro efficacies of caspofungin or micafungin catheter lock solutions on Candida albicans biofilm growth. J Antimicrob Chemother. 2008;62:153–5.

    Article  PubMed  CAS  Google Scholar 

  29. Jacobson MJ, Piper KE, Nguyen G, Steckelberg JM, Patel R. In vitro activity of anidulafungin against Candida albicans biofilms. Antimicrob Agents Chemother. 2008;52:2242–3.

    Article  PubMed  CAS  Google Scholar 

  30. Kuhn DM, George T, Chandra J, Mukherjee PK, Ghannoum MA. Antifungal susceptibility of Candida biofilms: unique efficacy of amphotericin B lipid formulations and echinocandins. Antimicrob Agents Chemother. 2002;46:1773–80.

    Article  PubMed  CAS  Google Scholar 

  31. Pai MP, Samples ML, Mercier RC, Spilde MN. Activity and ultrastructural effects of antifungal combinations against simulated Candida endocardial vegetations. Antimicrob Agents Chemother. 2008;52:2367–76.

    Article  PubMed  CAS  Google Scholar 

  32. Ramage G, VandeWalle K, Bachmann SP, Wickes BL, López-Ribot JL. In vitro pharmacodynamic properties of three antifungal agents against preformed Candida albicans biofilms determined by time-kill studies. Antimicrob Agents Chemother. 2002;46:3634–6.

    Article  PubMed  CAS  Google Scholar 

  33. Serena C, Mariné M, Quindós G, Carrillo AJ, Cano JF, Pastor FJ, Guarro J. In vitro interactions of micafungin with amphotericin B against clinical isolates of Candida spp. Antimicrob Agents Chemother. 2008;52:1529–32.

    Article  PubMed  CAS  Google Scholar 

  34. Shuford JA, Piper KE, Steckelberg JM, Patel R. In vitro biofilm characterization and activity of antifungal agents alone and in combination against sessile and planktonic clinical Candida albicans isolates. Diagn Microbiol Infect Dis. 2007;57:277–81.

    Article  PubMed  CAS  Google Scholar 

  35. Norice CT, Smith FJ Jr, Solis N, Filler SG, Mitchell AP. Requirement for Candida albicans Sun41 in biofilm formation and virulence. Eukaryot Cell. 2007;6:2046–55.

    Article  PubMed  CAS  Google Scholar 

  36. Pai MP. Antifungal combinations against simulated Candida albicans endocardial vegetations. Antimicrob Agents Chemother. 2009;53(6):2629–31.

    Article  PubMed  CAS  Google Scholar 

  37. Chen SC, Slavin MA, Sorrell TC. Echinocandin antifungal drugs in fungal infections: a comparison. Drugs. 2011;71:11–41.

    Article  PubMed  CAS  Google Scholar 

  38. Salmi D, Bhat A, Corman L, Raff G, Satake N. Diagnostic challenges in native valve fungal endocarditis producing a massive septic pulmonary embolus. Nihon Ishinkin Gakkai Zasshi. 2010;51(4):207–10.

    Article  PubMed  Google Scholar 

  39. Chopra T, Bhargava A, Kumar S, Chopra A, Dhar S, Afonso L, Sobel JD. Candida kefyr endocarditis in a patient with hypertrophic obstructive cardiomyopathy. Am J Med Sci. 2010;339(2):188–9.

    Article  PubMed  Google Scholar 

  40. Groll AH, Mickiene D, Petraitis V, Petraitiene R, Ibrahim KH, Piscitelli SC, Bekersky I, Walsh TJ. Compartmental pharmacokinetics and tissue distribution of the antifungal echinocandin lipopeptide micafungin (FK463) in rabbits. Antimicrob Agents Chemother. 2001;45:3322–7.

    Article  PubMed  CAS  Google Scholar 

  41. Yamada N, Kumada K, Kishino S, Mochizuki N, Ohno K, Ogura S. Distribution of micafungin in the tissue fluids of patients with invasive fungal infections. J Infect Chemother. 2011;17:731–4.

    Article  PubMed  CAS  Google Scholar 

  42. Pfaller MA, Sheehan DJ, Rex JH. Determination of fungicidal activities against yeasts and molds: lessons learned from bactericidal testing and the need for standardization. Clin Microbiol Rev. 2004;17:268–80.

    Article  PubMed  CAS  Google Scholar 

  43. Nicasio AM, Tessier PR, Nicolau DP, Knauft RF, Russomanno J, Shore E, Kuti JL. Bronchopulmonary disposition of micafungin in healthy adult volunteers. Antimicrob Agents Chemother. 2009;53:1218–20.

    Article  PubMed  CAS  Google Scholar 

  44. Nakagawa Y, Ichii Y, Saeki Y, Kodaka M, Suzuki K, Kishino S. Plasma concentration of micafungin in patients with hematologic malignancies. J Infect Chemother. 2007;13:39–45.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

The authors wish to thank the nurse staff and technicians at the Santa Chiara University Hospital, Pisa.

Conflict of interest

In the past 2 years, Dr Carlo Tascini has been paid for lectures on behalf of Pfizer, Novartis, Merck and Astellas.

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Authors and Affiliations

  1. U.O. Malattie Infettive, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy

    Carlo Tascini, Enrico Tagliaferri, Sarah Flammini, Alessandro Leonildi & Francesco Menichetti

  2. U.O. Cardiologia II, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy

    Maria Grazia Bongiorni, Ezio Soldati & Andrea Di Cori

  3. Divisione di Farmacologia e Chemioterapia, Università di Pisa, Pisa, Italy

    Antonello Di Paolo

  4. U.O. Malattie Infettive, Nuovo Santa Chiara Hospital, Via Paradisa 2, 56100, Pisa, Italy

    Enrico Tagliaferri

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  1. Carlo Tascini
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Correspondence to Enrico Tagliaferri.

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Tascini, C., Bongiorni, M.G., Tagliaferri, E. et al. Micafungin for Candida Albicans Pacemaker-Associated Endocarditis: A Case Report and Review of the Literature. Mycopathologia 175, 129–134 (2013). https://doi.org/10.1007/s11046-012-9591-2

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  • DOI: https://doi.org/10.1007/s11046-012-9591-2

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