Arch Intern Med
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Pseudomonas aeruginosa has emerged into the limelight mainly as a result of compromised host problems and the development of resistance leading to serious treatment difficulties. The organism possesses virulence factor that produce an effect in certain clinical situations. Changes in local anatomy, often with the presence of foreign bodies, are important (bladder and intravenous catheters, tracheostomy, burns, wounds, and injuries). ⋯ A mucoid form of P aeruginosa is a characteristic feature of cystic fibrosis. Resistance of P aeruginosa to antibiotics is very definitely associated with overuse of broad-spectrum antibiotics in hospitals. New and more effective antibiotics may be needed.
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An unconventional presentation of an elderly man with sepsis and a nonfunctioning permanent cardiac pacemaker is reviewed. Our interpretations of signs of an acute abdomen and laboratory evidence suggestive of acute cholecystitis did not lead to the correct diagnosis. The pacemaker electrode had perforated the myocardium and this event is believed to be secondary to bacterial endocarditis at the electrode tip. The therapeutic implications of this unique case are discussed.