Journal
CLINICAL INFECTIOUS DISEASES
Volume 57, Issue 10, Pages 1438-1448Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/cid/cit536
Keywords
device-related infections; LVAD; endocarditis; driveline infections; heart failure
Categories
Funding
- Department of Medicine, Mayo Foundation for Medical Education and Research
- Division of Infectious Diseases, Mayo Clinic College of Medicine
- National Center for Research Resources, National Institutes of Health [UL1 RR024150]
- [UL1 TR000135]
Ask authors/readers for more resources
Background. Infection is a serious complication of left ventricular assist device (LVAD) therapy. Published data regarding LVAD-associated infections (LVADIs) are limited by single-center experiences and use of nonstandardized definitions. Methods. We retrospectively reviewed 247 patients who underwent continuous-flow LVAD implantation from January 2005 to December 2011 at Mayo Clinic campuses in Minnesota, Arizona, and Florida. LVADIs were defined using the International Society for Heart and Lung Transplantation criteria. Results. We identified 101 episodes of LVADI in 78 patients (32%) from this cohort. Mean age (+/- standard deviation [SD]) was 57 +/- 15 years. The majority (94%) underwent Heartmate II implantation, with 62% LVADs placed as destination therapy. The most common type of LVADIs were driveline infections (47%), followed by bloodstream infections (24% VAD related, and 22% non-VAD related). The most common causative pathogens included gram-positive cocci (45%), predominantly staphylococci, and nosocomial gram-negative bacilli (27%). Almost half (42%) of the patients were managed by chronic suppressive antimicrobial therapy. While 14% of the patients had intraoperative debridement, only 3 underwent complete LVAD removal. The average duration (+/- SD) of LVAD support was 1.5 +/- 1.0 years. At year 2 of follow-up, the cumulative incidence of all-cause mortality was estimated to be 43%. Conclusion. Clinical manifestations of LVADI vary on the basis of the type of infection and the causative pathogen. Mortality remained high despite combined medical and surgical intervention and chronic suppressive antimicrobial therapy. Based on clinical experiences, a management algorithm for LVADI is proposed to assist in the decision-making process.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available