Permanent pacemaker associated infective endocarditis caused by a member of the HACEK group of organisms: a case report

The HACEK group of organisms have fastidious growth requirements and usually present as culture negative endocarditis. Probable Aggregatibacter aphrophilus has been isolated in a routine microbiology laboratory in a patient with a permanent pacemaker with echocardiographic features suggestive of lead endocarditis. Device removal, though recommended, was not carried out for clinical and economic reasons. The patient was successfully treated with antibiotics including intravenous ceftriaxone for the duration of two weeks plus oral cefixime for further 4 weeks together with regular and extended follow-up for more than one year while the pacemaker and the leads remained in-situ.