Original article: cardiovascular
Nosocomial bloodstream infections in patients with implantable left ventricular assist devices

https://doi.org/10.1016/S0003-4975(01)02888-0Get rights and content

Abstract

Background. Implantable left ventricular assist devices (LVAD) are used as a bridge to transplantation but are associated with a high risk of infection including nosocomial bloodstream infections (BSI).

Methods. We retrospectively reviewed the medical records of all patients with implantable LVAD at the Cleveland Clinic with 72 hours or longer of LVAD support from January 1992 through June 2000, to determine the attack rate, incidence, and impact of nosocomial BSI in patients with LVAD. A nosocomial BSI was defined using Centers for Disease Control and Prevention definition. An LVAD-related BSI was defined as one where the same pathogen is cultured from the device and the blood with no other obvious source. Two hundred fourteen patients were included in the study (17,831 LVAD-days).

Results. One hundred forty BSI were identified in 104 patients for an attack rate of 49% and incidence of 7.9 BSI per 1000 LVAD-days. Thirty-eight percent of the BSI were LVAD associated. The most common pathogens causing BSI were coagulase-negative staphylococci (n = 33), Staphylococcus aureus, and Candida spp. (19 each), and Pseudomonas aeruginosa (16 each). A Cox proportional hazard model found BSI in patients with LVAD to be significantly associated with death (hazard ratio = 4.02, p < 0.001). Fungemia had the highest hazard ratio (10.9), followed by gram-negative bacteremia (5.1), and gram-positive bacteremia (2.2).

Conclusions. Patients with implantable LVAD have a high incidence of BSI, which are associated with a significantly increased mortality. Strategies for prevention of infection in LVAD recipients should focus on the drive line exit site until technical advances can achieve a totally implantable device.

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)

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