Mycobacterium mageritenseによるペースメーカポケット感染の1例

Mycobacterium Mageritense Bacteremia after Implantation of Pacemaker；Report of a Case

はじめに　ペースメーカを含む植込み型心臓電気デバイス（cardiovascular implantable electronic devices：CIEDs）の感染は，難治性である1）．CIED感染に併発する菌血症，感染性心内膜炎あるいは抜去術時の出血によって生命を脅かされることもあり，抗菌薬の選択，デバイスの抜去方法や時期，新しいデバイスの植込み時期などを的確にしかも迅速に決めなければならない．非結核性抗酸菌の中でも迅速発育性抗酸菌の一種とされるMycobacterium mageritense（M. mageritense）によるペースメーカポケット感染経験を報告する．

An octogenarian female patient underwent implantation of pacemaker for sick sinus syndrome. Seventeen days after implantation, she came back to our hospital with pain and redness of the skin around the pacemaker generator. It was difficult to differentiate the infection from a subcutaneous hemorrhage. She did not have high fever. The blood test showed only a slight elevation of C-reactive protein （CRP）. Cefazolin was administered after readmission. Five days after readmission, the report of the blood culture showed nontuberculous Mycobacterium positive. We immediately removed the generator and the leads completely. Antibiotics were changed to clarithromycin and ciprofloxacin. The culture reports of blood, generator, leads, and subcutaneous tissue were first Mycobacterium peregrinum （M. peregrinum） but was later corrected to be Mycobacterium mageritense （M. mageritense）. Twenty-seven days after the removal of the device, she was transferred to another hospital near her family and antibiotics were ceased due to allergic reaction the day after transfer. Ten days after transfer, a new device was implanted, and she does not have any signs of infection now. The possibility of mycobacterial infection, including nontuberculous mycobacterial infection, should be considered for device contamination, especially for the aging population, and quick and proper treatments are required.