Original article: cardiovascularNosocomial bloodstream infections in patients with implantable left ventricular assist devices
Section snippets
Patient population
All patients undergoing an implantable LVAD at the Cleveland Clinic Foundation between January 1, 1992 and June 30, 2000, were included in the study. Patients were excluded if the duration of LVAD support was 72 hours or longer. If a patient received more than one LVAD, only the time of support on the initial device was included.
Data collection
Demographic, clinical, and microbiologic data were retrospectively abstracted from patient charts, pathology reports, and microbiology reports. During the study time
Results
A total of 236 LVAD were implanted in 226 patients at the Cleveland Clinic between January 1992 and June 30, 2000. Twelve patients had less than 72 hours of LVAD support and 8 patients had more than one device implanted. Therefore, 214 patients with 214 LVAD were included in the 8.5-year study period (17,831 LVAD-days). The mean age of patients was 50 years and LVAD recipients were predominately male (90%) and white (90%).
Almost all (97%) LVADs were implanted as a bridge to transplantation. The
Comment
The most important findings of our study are that patients with implantable ventricular assists devices have a high incidence of nosocomial BSI (approximately 8 per 1000 device-days), which are associated with increased mortality on device support. The associated increased mortality on device was highest for fungemia, followed by gram-negative bacteremia and gram-positive bacteremia. Infections associated with LVAD have significant implications but do not necessarily preclude successful
References (22)
- et al.
Clinical experience with long-term use of implantable left ventricular assist devicesindications, implantation, and outcomes
Semin Thorac Cardiothorac Surg
(2000) - et al.
Implantable LVAD infections. implications for permanent use of the device
Ann Thorac Surg
(1996) - et al.
CDC definitions for nosocomial infections
Am J Infect Control
(1988) - et al.
Management of left ventricular assist device infection with heart transplantation
Ann Thorac Surg
(1997) - et al.
Management of patients with end-stage heart disease treated with an implantable left ventricular assist device in a nontransplanting center
J Cardiothoracic Vasc Anesth
(2000) - et al.
Wound complications after left ventricular assist device implantation
Ann Thorac Surg
(2000) - et al.
Results of extended bridge to transplantationwindow into the future of permanent ventricular assist devices
Ann Thorac Surg
(1996) - et al.
A novel method to reduce device-related infections in patients supported with the HeartMate device
Ann Thorac Surg
(1999) - et al.
Infection during circulatory support with ventricular assist devices
Ann Thorac Surg
(1999) - et al.
Activation of T-cell death, and immune dysfunction after implantation of left ventricular after implantation of left ventricular device
Lancet
(1999)
Development of an infection-resistant LVAD drivelinea novel approach to the prevention of device-related infections
J Heart Lung Transplant
Cited by (136)
Mortality following durable left ventricular assist device implantation by timing and type of first infection
2023, Journal of Thoracic and Cardiovascular SurgeryLantibiotics in antifungal therapy: a futuristic approach
2023, Lantibiotics as Alternative TherapeuticsEpidemiology of infection in mechanical circulatory support: A global analysis from the ISHLT Mechanically Assisted Circulatory Support Registry
2019, Journal of Heart and Lung TransplantationCitation Excerpt :Although the epidemiology of infections has changed with the emergence of CF devices and destination therapy, published studies suggest that the microbiology of infections in MCS has not changed.25–29 These studies reported early and late infections were both predominantly due to bacteria, with a small proportion caused by fungi.26–38 The most common bacterial pathogens reported were gram-positive bacteria, typically Staphylococcus species (> 50%), organisms that colonize the skin and are associated with biofilm formation.
Ventricular Assist Device–Associated Infection
2018, Infectious Disease Clinics of North AmericaStaphylococcus aureus bloodstream infection in patients with ventricular assist devices–Management and outcome in a prospective bicenter cohort
2018, Journal of InfectionCitation Excerpt :The main findings of the present up-to-now largest series of VAD patients with SAB were: (i) the main portal of entry were the drivelines, (ii) the time between device implantation and onset of SAB was much longer than previously reported, (iii) all cause 30 day-mortality in SAB patients with VAD was comparable to mortality observed in SAB without VAD, (iv) the majority of patients had fever and significantly elevated infection markers at SAB onset, and (v) prompt sampling, adequate surgical management and optimized, ID consultation guided antibiotic therapy seemed to prevent haematogenous dissemination and led to clinical cure of SAB in 9 out of 12 cases. Our patients were almost exclusively male with a median age of 59 years which reflects the age/sex distribution for patients with VAD.8,9 It has been reported that VAD-related infections occur early after implantation due to a nosocomial contamination of device components or wound, exit site, or catheter-related infections.4,12,25
Anaesthesia for patients with left ventricular assist devices in noncardiac surgery
2018, Praticien en Anesthesie Reanimation