Coronary Stent Infection: An Esoteric Complication of a Common Procedure

1St. Luke's Hospital &
Health Network, Bethlehem, PA
2St. Luke's Hospital &
Health Network, Bethlehem, PA
3St. Luke's Hospital &
Health Network, Bethlehem, PA

Meeting: Hospital Medicine 2009, May 14-17, Chicago, Ill.

Abstract number: 181

Case Presentation:

A 58‐year‐old white man underwent primary percutaneous transluminal intervention (PCI) with 2 stents for acute coronary syndrome (ACS). On the second day he developed fever. Antecubital thrombophlebitis was noted, and the peripheral catheter was removed. The femoral site was clean. Blood cultures grew methicillin‐sensitive Staphylococcus aureus (MSSA), TEE was negative. He was started on nafcillin, and repeat blood cultures were negative. He was discharged to complete a 2‐week course of nafcillin. Two days after completion of nafcillin he developed a high‐grade fever and leukocytosis. Examination was entirely normal with no signs of infection. Two sets of blood cultures were again positive for MSSA. A search for a potential source of infection with urine culture, repeat TEE, Doppler of the lower extremities, a CT scan of chest and abdomen, and indium scan was negative. Nafcillin was restarted, and the patient was offered surgery for removal of stent but he refused, He was continued on antibiotics, and repeat blood cultures were sterile. He was treated for 6 weeks and became asymptomatic.

Discussion:

Deiter proposed criteria for diagnosis of coronary artery stent infection are a definitive diagnosis is by autopsy, and possible diagnosis if 3 of the following are positive: coronary stent placement in the preceding 4 weeks, multiple repeat procedures through the same sheath or complication at the site of arterial puncture, bacteremia, significant fevers in the absence of known bacterial infection, leukocytosis in the absence of known ACS or bacterial infection, ACS, and cardiac imaging consistent with persistent inflammation. This patient fulfilled 4 of the 7 criteria and also fulfilled the definition of intravascular infection, as all other potential sources of infection were excluded. The coronary stent infection was not primarily a result of the PCI procedure but occurred secondarily through bacteremic seeding of the stent from thrombophlebitis. Intravascular infection should be treated for 6 weeks, but as the initial course of antibiotic was only 2 weeks he relapsed in the presence of stent infection.

Conclusions:

In the United States 1.5 million patients receive coronary artery stents annually. However, stent infections remain remarkably uncommon, and the diagnostic criteria are evolving. A stent infection may be associated with considerable morbidity and mortality, and a high index of suspicion should be exercised with all patients who develop fever after PCI and stent. Rapid institution of antibiotics is the main stay of therapy, and surgical removal of the stent may be required. The risk can be reduced by strictly adhering to current standards for the prevention of infection during catheterization Despite the high morbidity and mortality of stent infection, routine use of systemic antibiotics is not advocated for prophylaxis because of its low incidence

Author Disclosure:

J. Pamula, none; S. Nanda, none; T. Le, none.

To cite this abstract:

Pamula J, Nanda S, Le T. Coronary Stent Infection: An Esoteric Complication of a Common Procedure. Abstract published at Hospital Medicine 2009, May 14-17, Chicago, Ill. Abstract 181. Journal of Hospital Medicine. 2009; 4 (suppl 1). https://www.shmabstracts.com/abstract/coronary-stent-infection-an-esoteric-complication-of-a-common-procedure/. Accessed March 20, 2019.

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