Dietzia species pacemaker pocket infection: an unusual organism in human infections

Summary

An 87-year-old man presented 10 months following permanent pacemaker insertion with cellulitis-like inflammation around the impulse generator. Symptoms improved with oral flucloxacillin, but only days after stopping, the infection recurred, and he was admitted from clinic for intravenous antibiotics. Suspecting the source was likely Staphylococcal, intravenous flucloxacillin was started, and the patient’s inflammatory markers responded adequately. Two samples of fluid were aspirated from the pacemaker site. These showed no bacterial growth using routine microbiological culture techniques. The samples were sent for 16S rDNA PCR and Dietzia species was detected in both samples. Dietzia species is an Actinomyces-like organism, which is not commonly associated with human infection, but is reported to have been isolated from clinical specimens and thus presumptively associated with human disease. The pacemaker was explanted and the pocket debrided with no complications. He made a full recovery after a prolonged course of flucloxacillin.